Healthcare Provider Details

I. General information

NPI: 1356959563
Provider Name (Legal Business Name): JOHN VUONG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 OLD PADONIA RD
COCKEYSVILLE MD
21030-4917
US

IV. Provider business mailing address

23323 ROBIN SONG DR
CLARKSBURG MD
20871-4444
US

V. Phone/Fax

Practice location:
  • Phone: 410-560-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17004
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: