Provider Demographics
NPI:1093385288
Name:VUONG, PHU (DMD)
Entity Type:Individual
Prefix:
First Name:PHU
Middle Name:
Last Name:VUONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 FIELDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-6541
Mailing Address - Country:US
Mailing Address - Phone:972-809-8850
Mailing Address - Fax:
Practice Address - Street 1:610 GILMER ST STE 1B
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4193
Practice Address - Country:US
Practice Address - Phone:903-458-6821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX373451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice