MEDICARE: DR. VIN X VU DDS

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	5240-015	WI

General Provider Information

NPI Number	:	1619978681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIN X VU DDS

Provider Business Mailing Address
First Line	:	364 FOREST VIEW RD
Second Line	:
City	:	OSHKOSH
State	:	WI
Zip	:	54904-7662
Country	:	US
Telephone Number	:	920-235-0320
Fax Number	:

Provider Business Practice Location Address
First Line	:	1013 N MAIN ST
Second Line	:
City	:	OSHKOSH
State	:	WI
Zip	:	54901-3837
Country	:	US
Telephone Number	:	920-235-0320
Fax Number	:

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	03/08/2013

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