Provider Demographics
NPI:1902011794
Name:1ST IMPRESSIONS DENTAL & DENTURE, PLLC
Entity Type:Organization
Organization Name:1ST IMPRESSIONS DENTAL & DENTURE, PLLC
Other - Org Name:1ST IMPRESSIONS DENTAL & DENTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTURIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QUOC
Authorized Official - Middle Name:W
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:LD
Authorized Official - Phone:2067-638-8883
Mailing Address - Street 1:9835 16TH AVE SW STE 101
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-2830
Mailing Address - Country:US
Mailing Address - Phone:206-763-8883
Mailing Address - Fax:206-768-8887
Practice Address - Street 1:9835 16TH AVE SW STE 101
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-2830
Practice Address - Country:US
Practice Address - Phone:206-763-8883
Practice Address - Fax:206-768-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered122400000XDental ProvidersDenturistGroup - Multi-Specialty