MEDICARE: DR. LIEM 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	122300000X	Dentist	3781	NV

General Provider Information

NPI Number	:	1982813960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIEM VU DDS

Provider Business Mailing Address
First Line	:	4975 S FORT APACHE RD
Second Line	:	STE. 107
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1702
Country	:	US
Telephone Number	:	702-248-2748
Fax Number	:	702-248-3748

Provider Business Practice Location Address
First Line	:	4975 S FORT APACHE RD
Second Line	:	STE. 107
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1702
Country	:	US
Telephone Number	:	702-248-2748
Fax Number	:	702-248-3748

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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