Provider Demographics
NPI:1639308307
Name:LIEM DUY DO DDS PLLC
Entity Type:Organization
Organization Name:LIEM DUY DO DDS PLLC
Other - Org Name:COMFORT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIEM
Authorized Official - Middle Name:DUY
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-696-0000
Mailing Address - Street 1:13510 NE 84TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-3092
Mailing Address - Country:US
Mailing Address - Phone:360-696-0000
Mailing Address - Fax:360-896-6264
Practice Address - Street 1:5409 NE ST JOHNS RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-2051
Practice Address - Country:US
Practice Address - Phone:360-253-1000
Practice Address - Fax:360-896-6264
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIEM DUY DO DDS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE81591223G0001X
1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty