Provider Demographics
NPI:1245379866
Name:NGUYEN, TIEN-DAT N (DDS)
Entity Type:Individual
Prefix:
First Name:TIEN-DAT
Middle Name:N
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21903 43RD CT W
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-3600
Mailing Address - Country:US
Mailing Address - Phone:206-250-3282
Mailing Address - Fax:
Practice Address - Street 1:212 W WINESAP RD STE 104
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-9210
Practice Address - Country:US
Practice Address - Phone:425-778-4445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009120122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist