Healthcare Provider Details

I. General information

NPI: 1326487380
Provider Name (Legal Business Name): VAN KHANH MORIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2013
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 PLAZA DR STE J
COLUMBUS IN
47201-2940
US

IV. Provider business mailing address

530 PLAZA DR STE J
COLUMBUS IN
47201-2940
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-9335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberA12012000
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: