Healthcare Provider Details

I. General information

NPI: 1851430136
Provider Name (Legal Business Name): DZON MANH NGUYEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 NW 85TH ST
SEATTLE WA
98117-4298
US

IV. Provider business mailing address

1421 NW 85TH ST
SEATTLE WA
98117-4298
US

V. Phone/Fax

Practice location:
  • Phone: 206-789-0111
  • Fax: 206-789-8961
Mailing address:
  • Phone: 206-789-0111
  • Fax: 206-789-8961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number00007675
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: