Individual
TRI THUC TO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
2124 4TH AVE, SEATTLE, WA 98121-2308
(206) 296-3109
(206) 296-0184
Mailing address
1801 KITSAP PL NE, RENTON, WA 98059-6045
(425) 291-7268
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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