Healthcare Provider Details

I. General information

NPI: 1609167113
Provider Name (Legal Business Name): JOSHUA FON-ENG TEH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 BOREN AVE N
SEATTLE WA
98109
US

IV. Provider business mailing address

527 BOREN AVE N
SEATTLE WA
98109
US

V. Phone/Fax

Practice location:
  • Phone: 206-274-1211
  • Fax:
Mailing address:
  • Phone: 206-274-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD10179
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE60523967
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: