Provider Demographics
NPI:1538349550
Name:DARANOUVONG, ANN A (DH)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:A
Last Name:DARANOUVONG
Suffix:
Gender:F
Credentials:DH
Other - Prefix:
Other - First Name:ANONGPHONE
Other - Middle Name:
Other - Last Name:DARANOUVONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DH
Mailing Address - Street 1:PO BOX 24911
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0911
Mailing Address - Country:US
Mailing Address - Phone:206-788-3600
Mailing Address - Fax:206-652-5216
Practice Address - Street 1:720 8TH AVE S STE 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3033
Practice Address - Country:US
Practice Address - Phone:206-788-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00006905124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist