Provider Demographics
NPI:1912745795
Name:SE WON AN, DDS, PLLC
Entity type:Organization
Organization Name:SE WON AN, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SE WON
Authorized Official - Middle Name:
Authorized Official - Last Name:AN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-761-3000
Mailing Address - Street 1:3104 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-3330
Mailing Address - Country:US
Mailing Address - Phone:253-761-3000
Mailing Address - Fax:
Practice Address - Street 1:3104 S UNION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-3330
Practice Address - Country:US
Practice Address - Phone:253-761-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental