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General NPI Number Information
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NPI Number | 1952777377
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Entity Type | Individual
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Provider Name | ANDREW TRI-ANH GIA DINH DMD
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Gender | Male
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 5 HIDDEN PASS
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City | NEWPORT COAST
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State | CA
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Zip | 92657
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Country | US
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Telephone | 714-878-3954
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 17692
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City | IRVINE
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State | CA
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Zip | 92623-7692
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Country | US
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Telephone | 714-878-3954
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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 | LL-403-15
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 102456
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License Number State | CA
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