Individual
TAE OH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5108 196TH ST SW, #202, LYNNWOOD, WA 98036-6152
(425) 778-3636
(425) 640-8726
Mailing address
5108 196TH ST SW, #202, LYNNWOOD, WA 98036-6152
(425) 778-3636
(425) 640-8726
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8881
WA
Other
Enumeration date
07/17/2006
Last updated
07/06/2011
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