MEDICARE: VIET DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	376933-9921	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407158413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIET DENTISTRY

Provider Business Mailing Address
First Line	:	1819 W 3500 S
Second Line	:	SUITE 1A
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84119-3457
Country	:	US
Telephone Number	:	801-887-7264
Fax Number	:	801-908-5752

Provider Business Practice Location Address
First Line	:	1819 W 3500 S
Second Line	:	SUITE 1A
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84119-3457
Country	:	US
Telephone Number	:	801-887-7264
Fax Number	:	801-908-5752

Authorized Official
Title or Position	:	OWNER
Name	:	KIEU THIEN LE
Credential	:	D.D.S.
Telephone Number	:	801-887-7264

Provider Enumeration Date	:	11/23/2010
Last Update Date	:	11/23/2010

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Directions to “VIET DENTISTRY ” Practice Location

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