Provider Demographics
NPI:1801009014
Name:DIMAYUGA, RAFAEL DINO (DDS)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:DINO
Last Name:DIMAYUGA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8817 123RD LN NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5876
Mailing Address - Country:US
Mailing Address - Phone:360-658-3000
Mailing Address - Fax:360-653-1560
Practice Address - Street 1:3533 172ND ST NE
Practice Address - Street 2:BLDG B
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223
Practice Address - Country:US
Practice Address - Phone:360-658-3000
Practice Address - Fax:360-653-1560
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000103881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice