Individual
DR. LAURIE FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
10700 SE 174TH ST STE 101, RENTON, WA 98055-5472
(206) 296-4955
Mailing address
8012 17TH AVE NE, SEATTLE, WA 98115-4420
(206) 523-6506
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE00005993
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5019591
—
WA
Enumeration date
11/20/2006
Last updated
07/08/2007
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