Provider Demographics
NPI:1558589317
Name:DR. VONNY NGANTUNG, D.D.S, M.S.
Entity Type:Organization
Organization Name:DR. VONNY NGANTUNG, D.D.S, M.S.
Other - Org Name:NORTHWEST ORTHODONTIC SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGANTUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:503-659-7455
Mailing Address - Street 1:12100 SE STEVENS CT
Mailing Address - Street 2:SUITE: 102
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-4707
Mailing Address - Country:US
Mailing Address - Phone:503-659-7455
Mailing Address - Fax:503-659-7431
Practice Address - Street 1:12100 SE STEVENS CT
Practice Address - Street 2:SUITE: 102
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-4707
Practice Address - Country:US
Practice Address - Phone:503-659-7455
Practice Address - Fax:503-659-7431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD82941223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty