Provider Demographics
NPI:1104971241
Name:TABANDA, SIONY F (DPD)
Entity type:Individual
Prefix:
First Name:SIONY
Middle Name:F
Last Name:TABANDA
Suffix:
Gender:F
Credentials:DPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 S 4TH PL STE A
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-2400
Mailing Address - Country:US
Mailing Address - Phone:425-204-0499
Mailing Address - Fax:425-204-0521
Practice Address - Street 1:241 S 4TH PL STE A
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-2400
Practice Address - Country:US
Practice Address - Phone:425-204-0499
Practice Address - Fax:425-204-0521
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000200122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5027131Medicaid