Provider Demographics
NPI:1962056176
Name:CYNTHIA ALEGRE PS
Entity type:Organization
Organization Name:CYNTHIA ALEGRE PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEGRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-523-4179
Mailing Address - Street 1:15301 MAPLE VALLEY HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-8128
Mailing Address - Country:US
Mailing Address - Phone:425-523-4179
Mailing Address - Fax:425-529-9686
Practice Address - Street 1:15301 MAPLE VALLEY HWY STE 100
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-8128
Practice Address - Country:US
Practice Address - Phone:425-523-4179
Practice Address - Fax:425-529-9686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA20160208344792Medicaid