Provider Demographics
NPI:1871225136
Name:DINH, LUCKYM VAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUCKYM
Middle Name:VAN
Last Name:DINH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 HAMPDEN RD
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-4007
Mailing Address - Country:US
Mailing Address - Phone:484-343-3173
Mailing Address - Fax:
Practice Address - Street 1:3 KELLY DRIVER RD
Practice Address - Street 2:
Practice Address - City:LAUREL SPRINGS
Practice Address - State:NJ
Practice Address - Zip Code:08021-4823
Practice Address - Country:US
Practice Address - Phone:856-258-7064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043753122300000X, 1223G0001X
NJ22DI02924100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice