MEDICARE: TRI DENTAL PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1922681246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI DENTAL PLLC

Provider Business Mailing Address
First Line	:	9100 VANCE ST APT 218
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80021-7013
Country	:	US
Telephone Number	:	469-818-1368
Fax Number	:

Provider Business Practice Location Address
First Line	:	2983 W EVANS AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80219-5507
Country	:	US
Telephone Number	:	720-738-8888
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	TRI MINH VU
Credential	:	DDS
Telephone Number	:	469-818-1368

Provider Enumeration Date	:	05/04/2021
Last Update Date	:	05/04/2021

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