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General NPI Number Information
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NPI Number | 1821400433
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Entity Type | Organization
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Legal Business Name | LOAN NGUYEN, DDS PLLC
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Dates
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Enumeration Date | 05/30/2014
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Last Update Date | 05/30/2014
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Provider Practice Location Address
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Address Line | 5101 25TH AVE NE SUITE 6
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City | SEATTLE
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State | WA
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Zip | 98105-3225
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Country | US
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Telephone | 206-466-5810
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Fax | 206-466-5429
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Provider Business Mailing Address
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Address Line | 5101 25TH AVE NE SUITE 6
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City | SEATTLE
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State | WA
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Zip | 98105-3225
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Country | US
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Telephone | 206-466-5810
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Fax | 206-466-5429
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Authorized Official
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Title or Position | OWNER
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Name | DR. LOAN T NGUYEN
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Credential | DDS
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Telephone | 360-791-7019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DE60216703
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License Number State | WA
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