Provider Demographics
NPI:1235390808
Name:VU, VAN PHONG (DDS)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:PHONG
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 1:1700 S SUNNYLANE RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-3118
Mailing Address - Country:US
Mailing Address - Phone:405-670-5000
Mailing Address - Fax:405-670-5001
Practice Address - Street 1:1700 S SUNNYLANE RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3118
Practice Address - Country:US
Practice Address - Phone:405-670-5000
Practice Address - Fax:405-670-5001
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice