Provider Demographics
NPI:1548838279
Name:BLUE SKY DENT PLLC
Entity type:Organization
Organization Name:BLUE SKY DENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINH
Authorized Official - Middle Name:KHANH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-696-2322
Mailing Address - Street 1:1809 GOLDEN TRAIL CT STE 140
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4667
Mailing Address - Country:US
Mailing Address - Phone:972-242-2155
Mailing Address - Fax:
Practice Address - Street 1:1809 GOLDEN TRAIL CT STE 140
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4667
Practice Address - Country:US
Practice Address - Phone:972-242-2155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty