Provider Demographics
NPI:1508176595
Name:VO, HOANGVU M (DMD)
Entity Type:Individual
Prefix:
First Name:HOANGVU
Middle Name:M
Last Name:VO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 DORCHESTER AVE # 34
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-2921
Mailing Address - Country:US
Mailing Address - Phone:617-320-3559
Mailing Address - Fax:
Practice Address - Street 1:1370 DORCHESTER AVE # 32
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-2921
Practice Address - Country:US
Practice Address - Phone:617-320-3559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18555761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice