Provider Demographics
NPI:1578622387
Name:DU, THANH VIEN
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:VIEN
Last Name:DU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:VIEN
Other - Last Name:DU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:13513 W EARLL DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-3544
Mailing Address - Country:US
Mailing Address - Phone:623-215-2185
Mailing Address - Fax:623-215-2185
Practice Address - Street 1:3155 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-4035
Practice Address - Country:US
Practice Address - Phone:602-263-5126
Practice Address - Fax:602-263-5070
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD62941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice