Provider Demographics
NPI:1396425062
Name:SIGNORETTY, LIANA MAY (RDH)
Entity type:Individual
Prefix:
First Name:LIANA
Middle Name:MAY
Last Name:SIGNORETTY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 21ST DR
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-1428
Mailing Address - Country:US
Mailing Address - Phone:360-820-2397
Mailing Address - Fax:
Practice Address - Street 1:508 21ST DR
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1428
Practice Address - Country:US
Practice Address - Phone:360-820-2397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60771442124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist