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General NPI Number Information
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NPI Number | 1962754762
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Entity Type | Organization
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Legal Business Name | THERON MANSON DDS PS
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Dates
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Enumeration Date | 10/04/2012
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Last Update Date | 10/04/2012
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Provider Practice Location Address
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Address Line | 9750 NE 120TH PL #8
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City | KIRKLAND
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State | WA
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Zip | 98034-4207
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Country | US
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Telephone | 425-823-1909
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Fax | 425-823-8969
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Provider Business Mailing Address
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Address Line | 9750 NE 120TH PL #8
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City | KIRKLAND
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State | WA
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Zip | 98034-4207
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Country | US
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Telephone | 425-823-1909
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Fax | 425-823-8969
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Authorized Official
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Title or Position | DENTIST/PRESIDENT
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Name | THERON ANGUS MANSON
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Credential | DDS
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Telephone | 425-823-1909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9434
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License Number State | WA
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