Provider Demographics
NPI:1841727104
Name:ANGKANAWARAPHAN, LALITA (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:LALITA
Middle Name:
Last Name:ANGKANAWARAPHAN
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312A EVANSTON AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7209
Mailing Address - Country:US
Mailing Address - Phone:213-503-4663
Mailing Address - Fax:
Practice Address - Street 1:8511 GREENWOOD AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103
Practice Address - Country:US
Practice Address - Phone:206-782-8223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60814301125Q00000X, 1223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No125Q00000XDental ProvidersDentistOral Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program