MEDICARE: VAN PHONG VU DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6045	OK

General Provider Information

NPI Number	:	1235390808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VAN PHONG VU DDS

Provider Business Mailing Address
First Line	:	1700 S SUNNYLANE RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73115-3118
Country	:	US
Telephone Number	:	405-670-5000
Fax Number	:	405-670-5001

Provider Business Practice Location Address
First Line	:	1700 S SUNNYLANE RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73115-3118
Country	:	US
Telephone Number	:	405-670-5000
Fax Number	:	405-670-5001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	06/17/2008

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