Provider Demographics
NPI:1558491811
Name:SMITH, TUANH PHAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:TUANH
Middle Name:PHAM
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10314 GREENWOOD AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9144
Mailing Address - Country:US
Mailing Address - Phone:206-729-0273
Mailing Address - Fax:206-729-0278
Practice Address - Street 1:10314 GREENWOOD AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9144
Practice Address - Country:US
Practice Address - Phone:206-729-0273
Practice Address - Fax:206-729-0278
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000082161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5031059Medicaid