Provider Demographics
NPI:1962595074
Name:TATT, AUDREY KAREN (DDS)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:KAREN
Last Name:TATT
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 1:15419 NE 20TH
Mailing Address - Street 2:# 206
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3839
Mailing Address - Country:US
Mailing Address - Phone:425-747-9840
Mailing Address - Fax:425-747-2837
Practice Address - Street 1:15419 NE 20TH ST
Practice Address - Street 2:# 206
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3839
Practice Address - Country:US
Practice Address - Phone:425-747-9840
Practice Address - Fax:425-747-2837
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA8062122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist