Healthcare Provider Details

I. General information

NPI: 1629231949
Provider Name (Legal Business Name): NICOLE VU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VAN BAO VU

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7319 W COLONIAL DR
ORLANDO FL
32818-6746
US

IV. Provider business mailing address

2914 WILLOW BAY TER
CASSELBERRY FL
32707-6733
US

V. Phone/Fax

Practice location:
  • Phone: 407-294-9200
  • Fax: 407-294-1577
Mailing address:
  • Phone: 215-203-4679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN18439
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN18439
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: