Healthcare Provider Details

I. General information

NPI: 1629653548
Provider Name (Legal Business Name): TIFFANY T VU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 LAVISTA RD
TUCKER GA
30084-5142
US

IV. Provider business mailing address

5210 TOWN CENTER BLVD STE 310
PEACHTREE CORNERS GA
30092-3544
US

V. Phone/Fax

Practice location:
  • Phone: 678-904-6685
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN26443
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN123341
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number37902
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: