Provider Demographics
NPI:1356779680
Name:MERCER ISLAND PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:MERCER ISLAND PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-535-8189
Mailing Address - Street 1:7800 SE 27TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3087
Mailing Address - Country:US
Mailing Address - Phone:206-535-8189
Mailing Address - Fax:
Practice Address - Street 1:7800 SE 27TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3087
Practice Address - Country:US
Practice Address - Phone:206-535-8189
Practice Address - Fax:206-535-8263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000101961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty