Provider Demographics
NPI:1720826845
Name:KODAMA, JULIANA SARAH (DMD)
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:SARAH
Last Name:KODAMA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6808 39TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7443
Mailing Address - Country:US
Mailing Address - Phone:206-550-2922
Mailing Address - Fax:
Practice Address - Street 1:11800 NE 128TH ST STE 520
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7296
Practice Address - Country:US
Practice Address - Phone:425-820-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61560543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist