Healthcare Provider Details

I. General information

NPI: 1447539895
Provider Name (Legal Business Name): ANTHONY TAN VUONG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 COLBY AVE 3RD FLOOR
EVERETT WA
98201-4940
US

IV. Provider business mailing address

18025 63RD PL W
LYNNWOOD WA
98037-7206
US

V. Phone/Fax

Practice location:
  • Phone: 425-252-9333
  • Fax:
Mailing address:
  • Phone: 425-530-0920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60220356
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: