Provider Demographics
NPI:1538514203
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:DENTIST & PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-848-2331
Mailing Address - Street 1:5225 TACOMA MALL BLVD
Mailing Address - Street 2:SUITE E104
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7018
Mailing Address - Country:US
Mailing Address - Phone:253-474-3223
Mailing Address - Fax:253-473-6762
Practice Address - Street 1:5225 TACOMA MALL BLVD
Practice Address - Street 2:SUITE E104
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7018
Practice Address - Country:US
Practice Address - Phone:253-474-3223
Practice Address - Fax:253-473-6762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment