Provider Demographics
NPI:1447539895
Name:VUONG, ANTHONY TAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:TAN
Last Name:VUONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18025 63RD PL W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-7206
Mailing Address - Country:US
Mailing Address - Phone:425-530-0920
Mailing Address - Fax:
Practice Address - Street 1:3802 COLBY AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4940
Practice Address - Country:US
Practice Address - Phone:425-252-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602203561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice