Provider Demographics
NPI:1831642255
Name:CAROLINA FLORENCIO, DMD, PHD, PLLC
Entity Type:Organization
Organization Name:CAROLINA FLORENCIO, DMD, PHD, PLLC
Other - Org Name:BELLEVUE TULIP DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PHD
Authorized Official - Phone:206-375-8368
Mailing Address - Street 1:11216 NE 15TH ST
Mailing Address - Street 2:SUITEB
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3723
Mailing Address - Country:US
Mailing Address - Phone:425-451-8611
Mailing Address - Fax:
Practice Address - Street 1:11216 NE 15TH ST
Practice Address - Street 2:SUITEB
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3723
Practice Address - Country:US
Practice Address - Phone:425-451-8611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60659486122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty