Provider Demographics
NPI:1972002707
Name:DR. VU DENTAL OFFICE, INC.
Entity Type:Organization
Organization Name:DR. VU DENTAL OFFICE, INC.
Other - Org Name:DR. VU DENTAL OFFICE, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:THAI
Authorized Official - Middle Name:QUOC
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:909-428-0299
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:
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:909-429-8504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52788261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental