Healthcare Provider Details

I. General information

NPI: 1699100313
Provider Name (Legal Business Name): TOOTHSCALER DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 N CAPITOL AVE STE D
SAN JOSE CA
95132-1017
US

IV. Provider business mailing address

1036 SUMMERMIST CT
SAN JOSE CA
95122-3361
US

V. Phone/Fax

Practice location:
  • Phone: 408-262-6301
  • Fax:
Mailing address:
  • Phone: 408-597-2984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number44798
License Number StateCA

VIII. Authorized Official

Name: DR. KEVIN VU
Title or Position: DENTIST
Credential: D.M.D
Phone: 408-262-6301