Provider Demographics
NPI:1760847347
Name:PATRA ALATSIS DMD MS PS
Entity Type:Organization
Organization Name:PATRA ALATSIS DMD MS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRA
Authorized Official - Middle Name:V
Authorized Official - Last Name:ALATSIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:253-851-9473
Mailing Address - Street 1:4301 S PINE ST STE 231
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7205
Mailing Address - Country:US
Mailing Address - Phone:253-474-9473
Mailing Address - Fax:253-474-6457
Practice Address - Street 1:4301 S PINE ST STE 231
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7205
Practice Address - Country:US
Practice Address - Phone:253-474-9473
Practice Address - Fax:253-474-6457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 605230931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty