Provider Demographics
NPI:1487426409
Name:TRUDENTAL OF AUBURN SURGICAL CENTER
Entity type:Organization
Organization Name:TRUDENTAL OF AUBURN SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:XINGTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:323-868-6490
Mailing Address - Street 1:701 M ST NE STE 104
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4500
Mailing Address - Country:US
Mailing Address - Phone:253-833-9063
Mailing Address - Fax:253-833-9197
Practice Address - Street 1:701 M ST NE STE 104
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4500
Practice Address - Country:US
Practice Address - Phone:253-833-9063
Practice Address - Fax:253-833-9197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty