Provider Demographics
NPI:1407168388
Name:MOCK & TRAN-DILAY DENTISTRY PLLC
Entity Type:Organization
Organization Name:MOCK & TRAN-DILAY DENTISTRY PLLC
Other - Org Name:MOCK & TRAN DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN-DILAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-821-9300
Mailing Address - Street 1:12817 120TH AVE NE STE B
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12817 120TH AVE NE STE B
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3001
Practice Address - Country:US
Practice Address - Phone:425-821-9300
Practice Address - Fax:425-821-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000110201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty