Provider Demographics
NPI:1316153950
Name:LALLI, ASHOK AUGUSTINE (DDS)
Entity type:Individual
Prefix:
First Name:ASHOK
Middle Name:AUGUSTINE
Last Name:LALLI
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:MIDWAY DENTAL CENTER
Mailing Address - Street 2:26228 PACIFIC HWY SO
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032
Mailing Address - Country:US
Mailing Address - Phone:253-941-1889
Mailing Address - Fax:253-941-3363
Practice Address - Street 1:26228 PACIFIC HWY S
Practice Address - Street 2:MIDWAY DENTAL CENTER
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-6934
Practice Address - Country:US
Practice Address - Phone:253-941-1889
Practice Address - Fax:253-941-3363
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE0055201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice