=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215743919
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | XIAOYING DENG, DDS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2024
-----------------------------------------------------
Last Update Date | 12/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1246 STATE AVE STE C
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98270-3694
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-209-8744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8553 INTERLAKE AVE N UNIT C
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98103-4027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-517-0072
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | XIAOYING DENG
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 718-517-0072
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------