MEDICARE: DR. THUVAN THI VO DMD

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	DN013137	GA
2	122300000X	Dentist	DN18603	FL

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	:	1821076944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THUVAN THI VO DMD

Provider Business Mailing Address
First Line	:	10722 KETCHUM VALLEY DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-7185
Country	:	US
Telephone Number	:	813-671-0675
Fax Number	:	813-671-0695

Provider Business Practice Location Address
First Line	:	10722 KETCHUM VALLEY DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-7185
Country	:	US
Telephone Number	:	813-671-0675
Fax Number	:	813-670-0695

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	01/29/2013

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