MEDICARE: MAN VO AND TINA VO 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	46227	CA
2	122300000X	Dentist	47009	CA

General Provider Information

NPI Number	:	1689057614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAN VO AND TINA VO DDS

Provider Business Mailing Address
First Line	:	5013 ARLINGTON AVE STE A
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-2792
Country	:	US
Telephone Number	:	951-688-4772
Fax Number	:	951-688-0226

Provider Business Practice Location Address
First Line	:	5013 ARLINGTON AVE STE A
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-2792
Country	:	US
Telephone Number	:	951-688-4772
Fax Number	:	951-688-0226

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	DR. MAN MINH VO
Credential	:	DDS
Telephone Number	:	951-688-4772

Provider Enumeration Date	:	07/08/2015
Last Update Date	:	07/08/2015

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