Provider Demographics
NPI:1073525044
Name:VO, DAT MINH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAT
Middle Name:MINH
Last Name:VO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 E HIGHLAND AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4647
Mailing Address - Country:US
Mailing Address - Phone:909-883-6400
Mailing Address - Fax:909-883-3269
Practice Address - Street 1:1470 E HIGHLAND AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4647
Practice Address - Country:US
Practice Address - Phone:909-883-6400
Practice Address - Fax:909-883-3269
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA409961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice