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Individual

TOMOMI J IDA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DDS

Contact information

Practice address
111 SE EVERETT MALL WAY, EVERETT, WA 98208-3208
(425) 341-7827
Mailing address
4111 194TH ST SW, LYNNWOOD, WA 98036-4604
(425) 835-5200

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
DE61165856
WA
1223P0221X
Pediatric Dentistry
Primary
DE61165856
WA
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
03/24/2020
Last updated
03/03/2026
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