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General NPI Number Information
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NPI Number | 1548452774
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Entity Type | Organization
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Legal Business Name | QUYNH-THU THAI, D.D.S., A PROF. CORP.
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Dates
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Enumeration Date | 08/12/2007
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Last Update Date | 08/12/2007
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Provider Practice Location Address
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Address Line | 855 S MAIN AVE SUITE J
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City | FALLBROOK
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State | CA
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Zip | 92028-3351
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Country | US
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Telephone | 760-723-8599
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Fax | 760-723-6289
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Provider Business Mailing Address
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Address Line | 855 S MAIN AVE SUITE J
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City | FALLBROOK
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State | CA
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Zip | 92028-3351
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Country | US
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Telephone | 760-723-8599
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Fax | 760-723-6289
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. QUYNH-THU THAI
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Credential | D.D.S.
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Telephone | 760-723-8599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 37372
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License Number State | CA
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