Provider Demographics
NPI:1710574447
Name:THU VIET MAI DDS LLC
Entity Type:Organization
Organization Name:THU VIET MAI DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARGIULO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-569-2243
Mailing Address - Street 1:2014 S TOLLGATE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-5906
Mailing Address - Country:US
Mailing Address - Phone:410-569-2243
Mailing Address - Fax:410-569-2287
Practice Address - Street 1:2014 S TOLLGATE RD STE 108
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-5906
Practice Address - Country:US
Practice Address - Phone:410-569-2243
Practice Address - Fax:410-569-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty