Basic Information
Provider Information | |||||||||
NPI: | 1861672255 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KONING | ||||||||
FirstName: | PATRICIA | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DDS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6950 NE CAMPUS WAY | ||||||||
Address2: |   | ||||||||
City: | HILLSBORO | ||||||||
State: | OR | ||||||||
PostalCode: | 971245611 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5039522125 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 11011 MERIDIAN AVE N | ||||||||
Address2: | 104 | ||||||||
City: | SEATTLE | ||||||||
State: | WA | ||||||||
PostalCode: | 981338967 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2063650378 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/14/2007 | ||||||||
LastUpdateDate: | 04/29/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | 016.0046369 | VT | N |   | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 1223S0112X | DE 60145015 | WA | Y |   | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 1223S0112X | 2901018845 | MI | N |   | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 1223S0112X | 019.028235 | IL | N |   | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.