Provider Demographics
NPI:1013931120
Name:NGUYEN, THANH DUNG NGOC (DMD)
Entity Type:Individual
Prefix:DR
First Name:THANH DUNG
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ROCHELLE
Other - Middle Name:THANH-DUNG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:4311 NE SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4011
Mailing Address - Country:US
Mailing Address - Phone:425-235-7900
Mailing Address - Fax:425-235-7903
Practice Address - Street 1:4311 NE SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4011
Practice Address - Country:US
Practice Address - Phone:425-235-7900
Practice Address - Fax:425-235-7903
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000083751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice