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670 Nw Gilman Blvd Ste B3 Issaquah WA 98027-2444 | |
| (425) 557-6453 | |
| (425) 391-5556 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 670 Nw Gilman Blvd Ste B3, Issaquah, Washington |
| Authorized Official Name and Position | Dzon Manh Nguyen (PRESIDENT) |
| Authorized Official Contact | 4355576453 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
670 Nw Gilman Blvd Ste B3 Issaquah WA 98027-2444 Ph: (425) 557-6453 | 670 Nw Gilman Blvd Ste B3 Issaquah WA 98027-2444 Ph: (425) 557-6453 |
| NPI Number | 1689795593 |
|---|---|
| Provider Enumeration Date | 04/02/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689795593 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DE00008773 (Washington) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | DE00008172 (Washington) | Primary |
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