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General NPI Number Information
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NPI Number | 1528473386
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Entity Type | Individual
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Provider Name | KEVIN HIEU VU D.D.S., M.S., C.D.T
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Gender | Male
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 301 EAST HWY 377 STE 100
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City | GRANBURY
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State | TX
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Zip | 76048-1201
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Country | US
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Telephone | 817-579-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 2236 BALD EAGLE WAY
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-4138
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Country | US
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Telephone | 225-636-0024
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 6453
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 33331
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License Number State | TX
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