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General NPI Number Information
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NPI Number | 1164115713
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Entity Type | Individual
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Provider Name | MINH-TOM VAN DDS
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Gender | Male
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Dates
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Enumeration Date | 05/31/2023
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 423 E 23RD ST
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City | NEW YORK
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State | NY
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Zip | 10010-5011
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Country | US
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Telephone | 212-686-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 12420 W AUBURN AVE
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City | LAKEWOOD
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State | CO
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Zip | 80228-4986
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Country | US
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Telephone | 720-998-2963
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN.00205637
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 110503
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 064693
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License Number State | NY
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