Provider Demographics
NPI:1982707014
Name:TAVOULARIS, AMANDA LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LEE
Last Name:TAVOULARIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19505 76TH AVE W
Mailing Address - Street 2:STE 100
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036
Mailing Address - Country:US
Mailing Address - Phone:425-775-3613
Mailing Address - Fax:425-670-8966
Practice Address - Street 1:19505 76TH AVE W
Practice Address - Street 2:STE 100
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036
Practice Address - Country:US
Practice Address - Phone:425-775-3613
Practice Address - Fax:425-670-8966
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7460122300000X
124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered124Q00000XDental ProvidersDental Hygienist