# THERON MANSON DDS PS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962754762
- **Authorized official:** THERON ANGUS MANSON DDS (DENTIST/PRESIDENT)
- **Authorized official phone:** (425) 823-1909

## Contact information

- **Practice address:** 9750 NE 120TH PL \#8, KIRKLAND, WA 98034-4207
- **Practice address phone:** (425) 823-1909
- **Practice address fax:** (425) 823-8969
- **Mailing address:** 9750 NE 120TH PL \#8, KIRKLAND, WA 98034-4207
- **Mailing address phone:** (425) 823-1909
- **Mailing address fax:** (425) 823-8969

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 9434 | WA | Yes |

## Other

- **Enumeration date:** 10/04/2012
- **Last updated:** 10/04/2012