Provider Demographics
NPI:1114238524
Name:DRS. AUDREY T & THAI V. NGUYEN, PLLC
Entity Type:Organization
Organization Name:DRS. AUDREY T & THAI V. NGUYEN, PLLC
Other - Org Name:EDC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-272-6242
Mailing Address - Street 1:5717 PINNACLE CT NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422
Mailing Address - Country:US
Mailing Address - Phone:253-272-6242
Mailing Address - Fax:253-272-6243
Practice Address - Street 1:3415 AUBURN WAY S
Practice Address - Street 2:STE #1
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002
Practice Address - Country:US
Practice Address - Phone:253-272-6242
Practice Address - Fax:253-272-6242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WATBAMedicaid