Organization Name: | SMILE BRIGHT DENTURE CENTER LLC |
NPI Number: | 1912085390 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DUNG Q PHAM (DENTURIST) |
Mailing Address: | 315 E Casino Rd Suite B Everett |
State: | WA US |
Postal Code: | 982081846 |
Phone Number: | 4253554409 |
Fax Number: | |
NPI Enumeration Date: | 11/01/2006 |
NPI Last Update Date: | 05/01/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 122400000X |
License Number: | DN00000360 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Denturist |
Taxonomy Specialization: | |
Taxonomy Definition: |