Provider Demographics
NPI:1992381560
Name:PACIFIC SEASTAR DENTAL PLLC
Entity Type:Organization
Organization Name:PACIFIC SEASTAR DENTAL PLLC
Other - Org Name:WHOLE BODY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-305-9445
Mailing Address - Street 1:1811 156TH AVE NE STE 6
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-4344
Mailing Address - Country:US
Mailing Address - Phone:425-643-1231
Mailing Address - Fax:
Practice Address - Street 1:1811 156TH AVE NE STE 6
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4344
Practice Address - Country:US
Practice Address - Phone:425-643-1231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental