Provider Demographics
NPI:1891364311
Name:CHE, VAN THI HAI (DMD)
Entity Type:Individual
Prefix:DR
First Name:VAN
Middle Name:THI HAI
Last Name:CHE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:VAN
Other - Middle Name:T
Other - Last Name:CHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:10667 BRIGHTMAN BLVD APT 2403
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7511
Mailing Address - Country:US
Mailing Address - Phone:407-864-6269
Mailing Address - Fax:
Practice Address - Street 1:7885 NORMANDY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-6640
Practice Address - Country:US
Practice Address - Phone:904-441-5908
Practice Address - Fax:904-783-1633
Is Sole Proprietor?:No
Enumeration Date:2021-06-19
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN260681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice