MEDICARE: TOM VU DENTAL CORP

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	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1912144114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOM VU DENTAL CORP

Provider Business Mailing Address
First Line	:	7171 WARNER AVE
Second Line	:	SUITE #C
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5478
Country	:	US
Telephone Number	:	714-842-7000
Fax Number	:	714-842-7311

Provider Business Practice Location Address
First Line	:	7171 WARNER AVE
Second Line	:	SUITE #C
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5478
Country	:	US
Telephone Number	:	714-842-7000
Fax Number	:	714-842-7311

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. TOM T VU
Credential	:	DMD
Telephone Number	:	714-357-9958

Provider Enumeration Date	:	01/10/2009
Last Update Date	:	08/15/2014

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