Healthcare Provider Details

I. General information

NPI: 1598860579
Provider Name (Legal Business Name): VINH P HUYNH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1568 INDIAN TRAIL LILBURN RD SUITE 201
NORCROSS GA
30093-2613
US

IV. Provider business mailing address

1568 INDIAN TRAIL LILBURN RD SUITE 201
NORCROSS GA
30093-2613
US

V. Phone/Fax

Practice location:
  • Phone: 770-840-9500
  • Fax: 770-840-9603
Mailing address:
  • Phone: 770-840-9500
  • Fax: 770-840-9603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number012034
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: