Provider Demographics
NPI:1568769008
Name:DINH, LAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAN
Middle Name:
Last Name:DINH
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 1:13110 ELK MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7182
Mailing Address - Country:US
Mailing Address - Phone:813-653-6208
Mailing Address - Fax:813-685-2110
Practice Address - Street 1:2814 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-5471
Practice Address - Country:US
Practice Address - Phone:813-349-7800
Practice Address - Fax:813-938-6421
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN163171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice