Provider Demographics
NPI:1578638672
Name:DUONG, NGA ANH (DMD)
Entity type:Individual
Prefix:
First Name:NGA
Middle Name:ANH
Last Name:DUONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21105 SR 401E
Mailing Address - Street 2:SUITE G4
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391
Mailing Address - Country:US
Mailing Address - Phone:253-299-6730
Mailing Address - Fax:253-862-8921
Practice Address - Street 1:21105 SR 410 E
Practice Address - Street 2:SUITE G-4
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8457
Practice Address - Country:US
Practice Address - Phone:253-299-6730
Practice Address - Fax:253-862-8921
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABD9843803122300000X
NV51751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice