Healthcare Provider Details

I. General information

NPI: 1346779493
Provider Name (Legal Business Name): CHRISTINE VU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2017
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 VEY WAY
THE DALLES OR
97058-1066
US

IV. Provider business mailing address

10765 GREEN VALLEY DR
GILROY CA
95020-9316
US

V. Phone/Fax

Practice location:
  • Phone: 541-370-7120
  • Fax:
Mailing address:
  • Phone: 408-829-4826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN23228
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 NumberD11175
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: