Provider Demographics
NPI:1871666883
Name:WAN, VICTORIA M (DDS)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:WAN
Suffix:
Gender:F
Credentials:DDS
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Mailing Address - Street 1:16400 SOUTHCENTER PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-3335
Mailing Address - Country:US
Mailing Address - Phone:206-575-0400
Mailing Address - Fax:206-575-6469
Practice Address - Street 1:16400 SOUTHCENTER PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-3335
Practice Address - Country:US
Practice Address - Phone:206-575-0400
Practice Address - Fax:206-575-6469
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WADE000104951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics