=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154815058
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRI MINH VU DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2018
-----------------------------------------------------
Last Update Date | 09/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2983 W EVANS AVE
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80219-5507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-818-1368
-----------------------------------------------------
Fax | 720-738-8888
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2983 W EVANS AVE
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80219-5507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-818-1368
-----------------------------------------------------
Fax | 720-738-8888
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 34001
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 00204172
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------