Provider Demographics
NPI:1548013014
Name:EMERSON DENTAL INC PC
Entity type:Organization
Organization Name:EMERSON DENTAL INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHUONG
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-906-5116
Mailing Address - Street 1:1339 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6552
Mailing Address - Country:US
Mailing Address - Phone:253-565-2895
Mailing Address - Fax:253-565-2702
Practice Address - Street 1:1339 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6552
Practice Address - Country:US
Practice Address - Phone:253-565-2895
Practice Address - Fax:253-565-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental