Provider Demographics
NPI:1891073581
Name:MAI, THU VIET (DDS)
Entity Type:Individual
Prefix:DR
First Name:THU
Middle Name:VIET
Last Name:MAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:THU
Other - Middle Name:M
Other - Last Name:VERSTEEGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60631122300000X
MD156341223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist