Provider Demographics
NPI:1558768739
Name:WONG HSU ON SU & LIAO DDS PLLC
Entity Type:Organization
Organization Name:WONG HSU ON SU & LIAO DDS PLLC
Other - Org Name:RENTON DENTAL PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-234-4179
Mailing Address - Street 1:601 S CARR RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5866
Mailing Address - Country:US
Mailing Address - Phone:425-228-1033
Mailing Address - Fax:425-226-2308
Practice Address - Street 1:601 S CARR RD
Practice Address - Street 2:SUITE 400
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5866
Practice Address - Country:US
Practice Address - Phone:425-228-1033
Practice Address - Fax:425-226-2308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty