Healthcare Provider Details

I. General information

NPI: 1104017144
Provider Name (Legal Business Name): MARY MEITZU HUANG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 NW ANDERSON HILL RD
SILVERDALE WA
98383-9161
US

IV. Provider business mailing address

3505 NW ANDERSON HILL RD
SILVERDALE WA
98383-9161
US

V. Phone/Fax

Practice location:
  • Phone: 503-644-2170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00010939
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: