Provider Demographics
NPI:1689750739
Name:CERVANTES, MISTY ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MISTY
Middle Name:ANN
Last Name:CERVANTES
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 1:35455 8TH AVE SOUTHWEST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-8137
Mailing Address - Country:US
Mailing Address - Phone:209-406-3057
Mailing Address - Fax:
Practice Address - Street 1:1519 ALASKAN WAY S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1102
Practice Address - Country:US
Practice Address - Phone:206-217-6446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000105531223G0001X
CA528351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice