Provider Demographics
NPI:1649755935
Name:TAINA, ELIZABETH M (DDS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:TAINA
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 1:24015 SE KENT KANGLEY RD STE C
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-6802
Mailing Address - Country:US
Mailing Address - Phone:425-433-0600
Mailing Address - Fax:425-433-0877
Practice Address - Street 1:24015 SE KENT KANGLEY RD STE C
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-6802
Practice Address - Country:US
Practice Address - Phone:425-433-0600
Practice Address - Fax:425-433-0877
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60864468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist