MEDICARE: TDH DENTAL PLLC

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

General Provider Information

NPI Number	:	1811705866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TDH DENTAL PLLC

Provider Business Mailing Address
First Line	:	PO BOX 173
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-0173
Country	:	US
Telephone Number	:	650-283-5130
Fax Number	:

Provider Business Practice Location Address
First Line	:	5959 SHALLOWFORD RD STE 539
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-2240
Country	:	US
Telephone Number	:	423-499-8007
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THUAN-VU DINH HO
Credential	:	DMD
Telephone Number	:	650-283-5130

Provider Enumeration Date	:	12/23/2024
Last Update Date	:	12/23/2024

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