=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265828305
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EKAPOJ THONGIN III, DMD, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2015
-----------------------------------------------------
Last Update Date | 04/15/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17215 SMOKEY POINT DR
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98223-8798
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-651-9828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17215 SMOKEY POINT DR
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98223-8798
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. EKAPOJ THONGIN
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 360-651-9828
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | DE7158
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------