Healthcare Provider Details

I. General information

NPI: 1093385288
Provider Name (Legal Business Name): PHU VUONG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 GILMER ST STE 1B
SULPHUR SPRINGS TX
75482-4193
US

IV. Provider business mailing address

3109 FIELDVIEW DR
GARLAND TX
75044-6541
US

V. Phone/Fax

Practice location:
  • Phone: 903-458-6821
  • Fax:
Mailing address:
  • Phone: 972-809-8850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37345
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: