Healthcare Provider Details

I. General information

NPI: 1538514203
Provider Name (Legal Business Name): BROUGHTON DUNN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 TACOMA MALL BLVD SUITE E104
TACOMA WA
98409-7018
US

IV. Provider business mailing address

5225 TACOMA MALL BLVD SUITE E104
TACOMA WA
98409-7018
US

V. Phone/Fax

Practice location:
  • Phone: 253-474-3223
  • Fax: 253-473-6762
Mailing address:
  • Phone: 253-474-3223
  • Fax: 253-473-6762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateWA

VIII. Authorized Official

Name: DR. ANGELA DUNN
Title or Position: DENTIST & PARTNER
Credential: DDS
Phone: 253-848-2331