Provider Demographics
NPI:1902983695
Name:THIEN, ALVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:
Last Name:THIEN
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 1:100 N FRUITLAND ST STE E
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3814
Mailing Address - Country:US
Mailing Address - Phone:509-491-3388
Mailing Address - Fax:
Practice Address - Street 1:100 N FRUITLAND ST STE E
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3814
Practice Address - Country:US
Practice Address - Phone:509-491-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8923242OtherWASHINGTON STATE DLI CV#
WA0129616OtherWA STATE DEPT L&I NUMBER
WA5031315Medicaid