Provider Demographics
NPI:1114976347
Name:DINH, LAN THAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAN
Middle Name:THAI
Last Name:DINH
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 1:2920 S ARCHIBALD AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7303
Mailing Address - Country:US
Mailing Address - Phone:909-923-2273
Mailing Address - Fax:909-923-2284
Practice Address - Street 1:2920 S ARCHIBALD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7303
Practice Address - Country:US
Practice Address - Phone:909-923-2273
Practice Address - Fax:909-923-2284
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49743122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD49743Medicare ID - Type UnspecifiedDENTI-CAL