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General NPI Number Information
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NPI Number | 1407158413
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Entity Type | Organization
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Legal Business Name | VIET DENTISTRY
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 1819 W 3500 S SUITE 1A
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City | SALT LAKE CITY
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State | UT
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Zip | 84119-3457
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Country | US
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Telephone | 801-887-7264
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Fax | 801-908-5752
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Provider Business Mailing Address
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Address Line | 1819 W 3500 S SUITE 1A
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City | SALT LAKE CITY
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State | UT
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Zip | 84119-3457
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Country | US
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Telephone | 801-887-7264
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Fax | 801-908-5752
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Authorized Official
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Title or Position | OWNER
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Name | KIEU THIEN LE
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Credential | D.D.S.
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Telephone | 801-887-7264
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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 | 376933-9921
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License Number State | UT
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