Provider Demographics
NPI:1134615578
Name:NGUYEN, ELSIE AILEEN (DMD)
Entity type:Individual
Prefix:DR
First Name:ELSIE
Middle Name:AILEEN
Last Name:NGUYEN
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 1:1200 12TH AVE S STE 901
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2712
Mailing Address - Country:US
Mailing Address - Phone:206-548-3058
Mailing Address - Fax:206-262-0859
Practice Address - Street 1:9245 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-5569
Practice Address - Country:US
Practice Address - Phone:206-722-8444
Practice Address - Fax:206-721-6310
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAD.E.60861717122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist