Provider Demographics
NPI:1710077532
Name:ODA, DOLPHINE (BDS, MSC)
Entity Type:Individual
Prefix:DR
First Name:DOLPHINE
Middle Name:
Last Name:ODA
Suffix:
Gender:F
Credentials:BDS, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 NE PACIFIC ST
Mailing Address - Street 2:BOX 357131
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-7131
Mailing Address - Country:US
Mailing Address - Phone:206-543-4440
Mailing Address - Fax:206-543-8054
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:B241 HSB
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-7134
Practice Address - Country:US
Practice Address - Phone:206-543-4440
Practice Address - Fax:206-543-8054
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000086191223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA109907OtherL&I
WA7074222Medicaid
WA7074222Medicaid
WA8852644Medicare PIN