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General NPI Number Information
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NPI Number | 1639308307
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Entity Type | Organization
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Legal Business Name | LIEM DUY DO DDS PLLC
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 07/02/2009
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Provider Practice Location Address
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Address Line | 5409 NE ST JOHNS RD
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City | VANCOUVER
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State | WA
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Zip | 98661-2051
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Country | US
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Telephone | 360-253-1000
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Fax | 360-896-6264
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Provider Business Mailing Address
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Address Line | 13510 NE 84TH ST STE 105
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City | VANCOUVER
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State | WA
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Zip | 98682-3092
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Country | US
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Telephone | 360-696-0000
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Fax | 360-896-6264
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Authorized Official
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Title or Position | OWNER
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Name | DR. LIEM DUY DO
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Credential | DDS
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Telephone | 360-696-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE8159
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License Number State | WA
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