=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083988976
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNCOAST DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2012
-----------------------------------------------------
Last Update Date | 02/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8915 US HIGHWAY 301 N
-----------------------------------------------------
City | PARRISH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34219-8701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-776-9145
-----------------------------------------------------
Fax | 941-894-1181
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8915 US HIGHWAY 301 N
-----------------------------------------------------
City | PARRISH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34219-8701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-776-9145
-----------------------------------------------------
Fax | 941-894-1181
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/PRESIDENT
-----------------------------------------------------
Name | DR. JOSEPH THIEN VU
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 941-776-9145
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | DN16091
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------