Provider Demographics
NPI:1174235071
Name:TOLES, PHUONG
Entity type:Individual
Prefix:
First Name:PHUONG
Middle Name:
Last Name:TOLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SW 292ND ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-3502
Mailing Address - Country:US
Mailing Address - Phone:206-747-2339
Mailing Address - Fax:
Practice Address - Street 1:222 SW 292ND ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-3502
Practice Address - Country:US
Practice Address - Phone:206-747-2339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAD161232952126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant