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Individual
TRI THUC TO
Active
Individual
TRI THUC TO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
DE00010383
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5049747
—
WA
Enumeration date
11/20/2006
Last updated
10/14/2014
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