Provider Demographics
NPI:1770819245
Name:LEA, CARINA L (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARINA
Middle Name:L
Last Name:LEA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 41ST AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4408
Mailing Address - Country:US
Mailing Address - Phone:267-258-8522
Mailing Address - Fax:
Practice Address - Street 1:701 N 34TH ST STE 210
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-3414
Practice Address - Country:US
Practice Address - Phone:206-633-3636
Practice Address - Fax:206-633-3639
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0547141223E0200X
WADE601901141223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics