Provider Demographics
NPI:1528132305
Name:TO, TRI THUC (DDS)
Entity type:Individual
Prefix:
First Name:TRI
Middle Name:THUC
Last Name:TO
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 1:1801 KITSAP PL NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-6045
Mailing Address - Country:US
Mailing Address - Phone:425-291-7268
Mailing Address - Fax:
Practice Address - Street 1:2124 4TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2308
Practice Address - Country:US
Practice Address - Phone:206-296-3109
Practice Address - Fax:206-296-0184
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000103831223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5049747Medicaid