Provider Demographics
NPI:1386198331
Name:FLORENCIO, CAROLINA HABER (DMD, PHD)
Entity type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:HABER
Last Name:FLORENCIO
Suffix:
Gender:F
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:CAROLINA
Other - Middle Name:
Other - Last Name:FLORENCIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, PHD
Mailing Address - Street 1:4603 168TH CT NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5448
Mailing Address - Country:US
Mailing Address - Phone:425-420-4700
Mailing Address - Fax:
Practice Address - Street 1:11216 NE 15TH ST
Practice Address - Street 2:STE B
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3723
Practice Address - Country:US
Practice Address - Phone:425-451-8611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60659486122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1831642255OtherNPI TYPE 2- CAROLINA FLORENCIO/BELLEVUE TULIP DENTAL
WA1093166563OtherNPI TYPE2- DR ALAN NOHR &ASSOCIATES