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General NPI Number Information
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NPI Number | 1154862415
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Entity Type | Organization
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Legal Business Name | CNC-DENTAL
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Dates
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Enumeration Date | 03/19/2017
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Last Update Date | 03/19/2017
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Provider Practice Location Address
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Address Line | 4043 TRINITY MILLS RD #101
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City | DALLAS
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State | TX
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Zip | 75287-6778
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Country | US
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Telephone | 972-306-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 4043 TRINITY MILLS RD #101
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City | DALLAS
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State | TX
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Zip | 75287-6778
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Country | US
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Telephone | 972-306-2121
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Fax |
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Authorized Official
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Title or Position | D.D.S.
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Name | DR. QUOC VU
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Credential |
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Telephone | 972-306-2121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 22398
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License Number State | TX
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