Provider Demographics
NPI:1114096559
Name:VU, OLIVER BAO (DDS)
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:BAO
Last Name:VU
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 1:7201 FLORIN MALL DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2701
Mailing Address - Country:US
Mailing Address - Phone:916-392-3567
Mailing Address - Fax:916-392-9360
Practice Address - Street 1:7201 FLORIN MALL DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2701
Practice Address - Country:US
Practice Address - Phone:916-392-3567
Practice Address - Fax:916-392-9360
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA446381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB44638OtherDENTI-CAL