Healthcare Provider Details

I. General information

NPI: 1083907760
Provider Name (Legal Business Name): DAT K NGUYEN DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2011
Last Update Date: 05/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6706 MARTIN LUTHER KING JR WAY S
SEATTLE WA
98118-3217
US

IV. Provider business mailing address

6706 MARTIN LUTHER KING JR WAY S
SEATTLE WA
98118-3217
US

V. Phone/Fax

Practice location:
  • Phone: 206-722-6706
  • Fax: 206-722-6709
Mailing address:
  • Phone: 206-722-6706
  • Fax: 206-722-6709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DAT KHOA NGUYEN
Title or Position: MEMBER, MANAGER
Credential:
Phone: 206-722-6706