Provider Demographics
NPI:1750500617
Name:VU, TAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAN
Middle Name:
Last Name:VU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9798 BELLAIRE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3427
Mailing Address - Country:US
Mailing Address - Phone:713-541-9007
Mailing Address - Fax:713-988-3620
Practice Address - Street 1:9798 BELLAIRE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3427
Practice Address - Country:US
Practice Address - Phone:713-541-9007
Practice Address - Fax:713-988-3620
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17170OtherLICENSE NUMBER
TX481151OtherUNITED CONCORDIA ID