Provider Demographics
NPI:1649214925
Name:MASSOTH, DONNA LOUISE (DDS MSD PH D)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:LOUISE
Last Name:MASSOTH
Suffix:
Gender:F
Credentials:DDS MSD PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 SAND POINT WAY NE
Mailing Address - Street 2:#218
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3900
Mailing Address - Country:US
Mailing Address - Phone:206-524-3773
Mailing Address - Fax:206-526-7361
Practice Address - Street 1:4500 SAND POINT WAY NE
Practice Address - Street 2:#218
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3900
Practice Address - Country:US
Practice Address - Phone:206-524-3773
Practice Address - Fax:206-526-7361
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000059051223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics