Provider Demographics
NPI:1932463502
Name:MESSAH, MARTIN KRISTIANTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:KRISTIANTO
Last Name:MESSAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23510 44TH PL W
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-4399
Mailing Address - Country:US
Mailing Address - Phone:415-215-4857
Mailing Address - Fax:
Practice Address - Street 1:2709 BICKFORD AVE
Practice Address - Street 2:STE. A
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1766
Practice Address - Country:US
Practice Address - Phone:425-374-8451
Practice Address - Fax:425-374-8484
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60343308122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist