Provider Demographics
NPI:1629231949
Name:VU, NICOLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:VU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:VAN
Other - Middle Name:BAO
Other - Last Name:VU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2914 WILLOW BAY TER
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-6733
Mailing Address - Country:US
Mailing Address - Phone:215-203-4679
Mailing Address - Fax:
Practice Address - Street 1:7319 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-6746
Practice Address - Country:US
Practice Address - Phone:407-294-9200
Practice Address - Fax:407-294-1577
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18439122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist