Provider Demographics
NPI:1124224779
Name:VICHETH THAY, DDS, INC.
Entity Type:Organization
Organization Name:VICHETH THAY, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICHETH
Authorized Official - Middle Name:
Authorized Official - Last Name:THAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-885-1981
Mailing Address - Street 1:18250 ROSCOE BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4269
Mailing Address - Country:US
Mailing Address - Phone:818-885-1981
Mailing Address - Fax:818-885-1937
Practice Address - Street 1:18250 ROSCOE BLVD STE 230
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4269
Practice Address - Country:US
Practice Address - Phone:818-885-1981
Practice Address - Fax:818-885-1937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2008-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46531122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty