MEDICARE: GRAND CENTURY DENTAL CENTER

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	B44548	CA

General Provider Information

NPI Number	:	1669542866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND CENTURY DENTAL CENTER

Provider Business Mailing Address
First Line	:	1111 STORY RD
Second Line	:	STE 1037
City	:	SAN JOSE
State	:	CA
Zip	:	95122
Country	:	US
Telephone Number	:	408-999-0480
Fax Number	:	408-288-8212

Provider Business Practice Location Address
First Line	:	1111 STORY RD
Second Line	:	STE 1037
City	:	SAN JOSE
State	:	CA
Zip	:	95122
Country	:	US
Telephone Number	:	408-999-0480
Fax Number	:	408-288-8212

Authorized Official
Title or Position	:	OWNER
Name	:	HUNG MINH THAI
Credential	:	DDS
Telephone Number	:	408-999-0480

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	08/22/2020

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