Abc Dentistry

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

2855 Issued in WA

Legal business name

ABC DENTISTRY

Practice address

22625 Pacific Hwy S
Des Moines, WA 98198-5110

Phone

(206) 878-5665

Fax

(206) 870-1504

NPI assigned

Apr 12, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Luc Hoang

Title

Ceo

Phone

(206) 878-5665

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639393309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22625 PACIFIC HWY S",
            "city": "DES MOINES",
            "state": "WA",
            "postal_code": "981985110",
            "telephone_number": "206-878-5665",
            "fax_number": "206-870-1504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22625 PACIFIC HWY S",
            "city": "DES MOINES",
            "state": "WA",
            "postal_code": "981985110",
            "telephone_number": "206-878-5665",
            "fax_number": "206-870-1504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOANG",
        "authorized_official_first_name": "LUC",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "206-878-5665",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "WA",
            "license": "2855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5040043",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Preferred Provider Organization in Des Moines, WA
• Providers in Des Moines, WA by specialty
• Preferred Provider Organization in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.