Provider Demographics
NPI:1013795624
Name:VO DENTAL GROUP
Entity Type:Organization
Organization Name:VO DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY THUY TRINH
Authorized Official - Middle Name:
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-797-7373
Mailing Address - Street 1:18952 BROOKHURST ST UNIT B-6
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7306
Mailing Address - Country:US
Mailing Address - Phone:714-716-1155
Mailing Address - Fax:
Practice Address - Street 1:18952 BROOKHURST ST UNIT B-6
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7306
Practice Address - Country:US
Practice Address - Phone:714-716-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1336544048Medicaid
CA1205472495Medicaid