Provider Demographics
NPI:1346779493
Name:VU, CHRISTINE (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:VU
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 1:10765 GREEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-9316
Mailing Address - Country:US
Mailing Address - Phone:408-829-4826
Mailing Address - Fax:
Practice Address - Street 1:1025 VEY WAY
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-1066
Practice Address - Country:US
Practice Address - Phone:541-370-7120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-11
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23228122300000X
390200000X
ORD11175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program