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General NPI Number Information
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NPI Number | 1245304963
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Entity Type | Organization
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Legal Business Name | TOM VU DENTAL CORP
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 386 N HARBOR BLVD
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City | LA HABRA
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State | CA
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Zip | 90631
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Country | US
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Telephone | 714-357-9958
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Fax | 562-694-0775
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Provider Business Mailing Address
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Address Line | 5322 DOVERTON DR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649
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Country | US
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Telephone | 714-377-6691
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Fax |
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Authorized Official
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Title or Position | DENTIST PRESIDENT
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Name | TOM T VU
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Credential | DMD
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Telephone | 714-357-9958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 47580
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License Number State | CA
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