Provider Demographics
NPI:1588859425
Name:FAMILY DENTISTRY AT HAWKS PRAIRIE
Entity Type:Organization
Organization Name:FAMILY DENTISTRY AT HAWKS PRAIRIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRUYEN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-456-1000
Mailing Address - Street 1:9321 MARTIN WAY E.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516
Mailing Address - Country:US
Mailing Address - Phone:360-456-1000
Mailing Address - Fax:360-456-3515
Practice Address - Street 1:9321 MARTIN WAY E.
Practice Address - Street 2:SUITE 101
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516
Practice Address - Country:US
Practice Address - Phone:360-456-1000
Practice Address - Fax:360-456-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA00009847122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty