Provider Demographics
NPI:1114777588
Name:MUNOZ GUTIERREZ, TANIA LILIANA (DDS)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:LILIANA
Last Name:MUNOZ GUTIERREZ
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 1:1959 NE PACIFIC STREET, BOX 356365
Mailing Address - Street 2:ROOM B-440
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-3635
Mailing Address - Country:US
Mailing Address - Phone:206-543-0903
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC STREET
Practice Address - Street 2:ROOM B-440
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-3635
Practice Address - Country:US
Practice Address - Phone:206-543-0903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WADE61568005122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program