Healthcare Provider Details

I. General information

NPI: 1144659053
Provider Name (Legal Business Name): VIET HO D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AVENUE K SE STE 4
WINTER HAVEN FL
33880-4000
US

IV. Provider business mailing address

200 AVENUE K SE STE 4
WINTER HAVEN FL
33880-4000
US

V. Phone/Fax

Practice location:
  • Phone: 646-346-9943
  • Fax:
Mailing address:
  • Phone: 646-346-9943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number21720
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: