Provider Demographics
NPI:1639130586
Name:KOUTSOUMBAS, MARGARITA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARGARITA
Middle Name:
Last Name:KOUTSOUMBAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10004 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9349
Mailing Address - Country:US
Mailing Address - Phone:206-363-4300
Mailing Address - Fax:206-985-3682
Practice Address - Street 1:10004 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9349
Practice Address - Country:US
Practice Address - Phone:206-363-4300
Practice Address - Fax:206-985-3682
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000102181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice