Provider Demographics
NPI:1962820712
Name:MAI, KARYN (DDS)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:
Last Name:MAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22219 MOUNTAIN HWY E STE A3
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-7557
Mailing Address - Country:US
Mailing Address - Phone:253-275-1255
Mailing Address - Fax:253-275-1256
Practice Address - Street 1:22219 MOUNTAIN HWY E STE A3
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-7557
Practice Address - Country:US
Practice Address - Phone:253-275-1255
Practice Address - Fax:253-275-1256
Is Sole Proprietor?:No
Enumeration Date:2014-03-30
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WADE60543546122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program