Provider Demographics
NPI:1548937345
Name:BIRRI, SIPPARA METIKU
Entity type:Individual
Prefix:
First Name:SIPPARA
Middle Name:METIKU
Last Name:BIRRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20822 76TH AVE W APT 17
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7116
Mailing Address - Country:US
Mailing Address - Phone:206-643-7137
Mailing Address - Fax:
Practice Address - Street 1:19705 VIKING AVE NW STE 201
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8351
Practice Address - Country:US
Practice Address - Phone:360-616-3138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61119623124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist