Provider Demographics
NPI:1235279357
Name:DRS. THAI AND AUDREY NGUYENS, PLLC
Entity type:Organization
Organization Name:DRS. THAI AND AUDREY NGUYENS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:TRANG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-272-6242
Mailing Address - Street 1:1212 S 11TH ST
Mailing Address - Street 2:STE #20
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4021
Mailing Address - Country:US
Mailing Address - Phone:253-272-6242
Mailing Address - Fax:253-272-6243
Practice Address - Street 1:1212 S 11TH ST
Practice Address - Street 2:STE #20
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4021
Practice Address - Country:US
Practice Address - Phone:253-272-6242
Practice Address - Fax:253-272-6243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE88791223G0001X
WADE85691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5035837Medicaid