Provider Demographics
NPI:1659659142
Name:HUYNH, VINH T (DMD)
Entity Type:Individual
Prefix:DR
First Name:VINH
Middle Name:T
Last Name:HUYNH
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 1:1905 E MCKELLIPS RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2865
Mailing Address - Country:US
Mailing Address - Phone:480-526-3664
Mailing Address - Fax:
Practice Address - Street 1:1905 E MCKELLIPS RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2865
Practice Address - Country:US
Practice Address - Phone:480-526-3664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD96121223G0001X
AZD0087821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1659659142OtherPPO, HMO
AZ1659659142Medicaid