Provider Demographics
NPI:1235115528
Name:TRIEU, TUYET BA (DMD)
Entity Type:Individual
Prefix:DR
First Name:TUYET BA
Middle Name:
Last Name:TRIEU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4527 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-2309
Mailing Address - Country:US
Mailing Address - Phone:215-329-5962
Mailing Address - Fax:215-329-5962
Practice Address - Street 1:4527 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-2309
Practice Address - Country:US
Practice Address - Phone:215-329-5962
Practice Address - Fax:215-329-5962
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 024367L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice