Provider Demographics
NPI:1407023781
Name:MAI T. VU D.D.S.,INC.
Entity Type:Organization
Organization Name:MAI T. VU D.D.S.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAI
Authorized Official - Middle Name:T
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-951-2275
Mailing Address - Street 1:83 W MARCH LN
Mailing Address - Street 2:SUITE #6
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5730
Mailing Address - Country:US
Mailing Address - Phone:209-951-2275
Mailing Address - Fax:
Practice Address - Street 1:83 W MARCH LN
Practice Address - Street 2:SUITE #6
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5730
Practice Address - Country:US
Practice Address - Phone:209-951-2275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA513861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty