Provider Demographics
NPI:1508311762
Name:BROUGHTON DUNN PLLC
Entity Type:Organization
Organization Name:BROUGHTON DUNN PLLC
Other - Org Name:LIGHT DENTAL STUDIOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-848-2331
Mailing Address - Street 1:8012 112TH STREET CT E STE 320
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-7856
Mailing Address - Country:US
Mailing Address - Phone:253-848-2331
Mailing Address - Fax:253-840-4033
Practice Address - Street 1:8012 112TH STREET CT E STE 320
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-7856
Practice Address - Country:US
Practice Address - Phone:253-848-2331
Practice Address - Fax:253-840-4033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60661826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty