MEDICARE: DR. DAVID DAI VU MD

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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	25726	TX
2	208200000X	Plastic Surgery Physician	R2779	TX

General Provider Information

NPI Number	:	1467587089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID DAI VU MD

Provider Business Mailing Address
First Line	:	2325 STUTZ DR UNIT 43
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-6916
Country	:	US
Telephone Number	:	415-867-4636
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 W COLORADO BLVD STE 940
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-2394
Country	:	US
Telephone Number	:	214-843-1073
Fax Number	:	214-387-1362

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	05/24/2022

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