=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013795624
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VO DENTAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2023
-----------------------------------------------------
Last Update Date | 09/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18952 BROOKHURST ST UNIT B-6
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-7306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-716-1155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18952 BROOKHURST ST UNIT B-6
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-7306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-716-1155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | TIFFANY THUY TRINH VO
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 415-797-7373
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------