Provider Demographics
NPI:1568687721
Name:QUYEN THUC DUONG PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:QUYEN THUC DUONG PROFESSIONAL DENTAL CORPORATION
Other - Org Name:UNI DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QUYEN
Authorized Official - Middle Name:THUC
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-923-3073
Mailing Address - Street 1:175 S CAPITOL AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-2845
Mailing Address - Country:US
Mailing Address - Phone:408-923-3073
Mailing Address - Fax:408-923-3075
Practice Address - Street 1:175 S CAPITOL AVE
Practice Address - Street 2:SUITE E
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-2845
Practice Address - Country:US
Practice Address - Phone:408-923-3073
Practice Address - Fax:408-923-3075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-14
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA421461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty