Provider Demographics
NPI:1932282118
Name:BENCA, PATRICIA GALLAHER (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:GALLAHER
Last Name:BENCA
Suffix:
Gender:F
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ANDOVER PARK E STE 4
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2938
Mailing Address - Country:US
Mailing Address - Phone:206-575-1173
Mailing Address - Fax:206-575-0759
Practice Address - Street 1:200 ANDOVER PARK E STE 4
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2938
Practice Address - Country:US
Practice Address - Phone:206-575-1173
Practice Address - Fax:206-575-0759
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000063441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice