Provider Demographics
NPI:1952489247
Name:NGO, MARK T (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:NGO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16902 120TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-9588
Mailing Address - Country:US
Mailing Address - Phone:253-548-4372
Mailing Address - Fax:
Practice Address - Street 1:14820 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-4655
Practice Address - Country:US
Practice Address - Phone:253-537-9317
Practice Address - Fax:253-537-1371
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000096801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice