Provider Demographics
NPI:1790004869
Name:DODOBARAS,D.D.S.,P.S.
Entity Type:Organization
Organization Name:DODOBARAS,D.D.S.,P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-838-9996
Mailing Address - Street 1:33515 10TH PL. S. SUITE #12
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003
Mailing Address - Country:US
Mailing Address - Phone:253-838-9996
Mailing Address - Fax:253-815-9462
Practice Address - Street 1:33515 10TH PL S STE 12
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7300
Practice Address - Country:US
Practice Address - Phone:253-838-9996
Practice Address - Fax:253-815-9462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000034601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5044129Medicaid
WA5308804Medicaid