Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DE00010383 | WA |
NPI | 1528132305 |
---|---|
Provider Name | Tri Thuc To |
First Address | Renton, WA 98059-6045 |
Second Address | Seattle, WA 98121-2308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 14/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5049747 | (05) | WA |