Healthcare Provider Details

I. General information

NPI: 1952085797
Provider Name (Legal Business Name): VUONG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 STATE HIGHWAY 78 STE B
LAVON TX
75166-1288
US

IV. Provider business mailing address

622 LAUREL LN
WYLIE TX
75098-1816
US

V. Phone/Fax

Practice location:
  • Phone: 972-809-8850
  • Fax:
Mailing address:
  • Phone: 972-809-8850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PHU VUONG
Title or Position: OWNER
Credential: DMD
Phone: 972-809-8850