Healthcare Provider Details

I. General information

NPI: 1609781038
Provider Name (Legal Business Name): BROUGHTON DUNN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MARVIN RD NE STE 302
LACEY WA
98516-5710
US

IV. Provider business mailing address

8012 112TH STREET CT E STE 320
PUYALLUP WA
98373-7856
US

V. Phone/Fax

Practice location:
  • Phone: 360-459-8348
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DAVID MAI
Title or Position: ACCOUNTANT
Credential:
Phone: 253-848-2331