Healthcare Provider Details

I. General information

NPI: 1528132305
Provider Name (Legal Business Name): TRI THUC TO D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 4TH AVE
SEATTLE WA
98121-2308
US

IV. Provider business mailing address

1801 KITSAP PL NE
RENTON WA
98059-6045
US

V. Phone/Fax

Practice location:
  • Phone: 206-296-3109
  • Fax: 206-296-0184
Mailing address:
  • Phone: 425-291-7268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDE00010383
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: