Provider Demographics
NPI:1407158413
Name:VIET DENTISTRY
Entity Type:Organization
Organization Name:VIET DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIEU
Authorized Official - Middle Name:THIEN
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-887-7264
Mailing Address - Street 1:1819 W 3500 S
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-3457
Mailing Address - Country:US
Mailing Address - Phone:801-887-7264
Mailing Address - Fax:801-908-5752
Practice Address - Street 1:1819 W 3500 S
Practice Address - Street 2:SUITE 1A
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-3457
Practice Address - Country:US
Practice Address - Phone:801-887-7264
Practice Address - Fax:801-908-5752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT376933-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT647187297008Medicaid