MEDICARE: DR. THUBA TRIEU DMD

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	122300000X	Dentist	DS029162L	PA

General Provider Information

NPI Number	:	1518958594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THUBA TRIEU DMD

Provider Business Mailing Address
First Line	:	6536 WOODLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-2215
Country	:	US
Telephone Number	:	215-727-3773
Fax Number	:

Provider Business Practice Location Address
First Line	:	6536 WOODLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-2215
Country	:	US
Telephone Number	:	215-727-3773
Fax Number	:

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	09/16/2013

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