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General NPI Number Information
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NPI Number | 1912085390
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Entity Type | Organization
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Legal Business Name | SMILE BRIGHT DENTURE CENTER LLC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 315 E CASINO RD SUITE B
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City | EVERETT
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State | WA
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Zip | 98208-1846
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Country | US
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Telephone | 425-355-4409
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Fax |
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Provider Business Mailing Address
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Address Line | 315 E CASINO RD SUITE B
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City | EVERETT
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State | WA
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Zip | 98208-1846
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Country | US
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Telephone | 425-355-4409
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Fax |
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Authorized Official
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Title or Position | DENTURIST
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Name | MR. DUNG Q PHAM
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Credential | DN
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Telephone | 425-355-4409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122400000X
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Taxonomy Name | Denturist
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License Number | DN00000360
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License Number State | WA
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