Provider Demographics
NPI:1336793173
Name:DEA, MICAELA LORRAINE CLAUSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICAELA
Middle Name:LORRAINE CLAUSON
Last Name:DEA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MICAELA
Other - Middle Name:LORRAINE
Other - Last Name:DEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2003 132ND ST SE STE G
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7140
Mailing Address - Country:US
Mailing Address - Phone:425-337-1700
Mailing Address - Fax:
Practice Address - Street 1:2003 132ND ST SE STE G
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-7140
Practice Address - Country:US
Practice Address - Phone:425-337-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA609772791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice