Provider Demographics
NPI:1942356415
Name:VU, THAI QUOC (DMD)
Entity Type:Individual
Prefix:DR
First Name:THAI
Middle Name:QUOC
Last Name:VU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10660 SIERRA AVE STE J
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-7663
Mailing Address - Country:US
Mailing Address - Phone:909-428-0299
Mailing Address - Fax:
Practice Address - Street 1:10660 SIERRA AVE STE J
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-7663
Practice Address - Country:US
Practice Address - Phone:909-428-0299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice