Provider Demographics
NPI:1205924362
Name:VU, MINH TRANG NGOC (DDS)
Entity type:Individual
Prefix:DR
First Name:MINH
Middle Name:TRANG NGOC
Last Name:VU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 HACKNEY LN
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-6068
Mailing Address - Country:US
Mailing Address - Phone:219-477-2782
Mailing Address - Fax:773-374-9422
Practice Address - Street 1:7615 S JEFFERY BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-4015
Practice Address - Country:US
Practice Address - Phone:773-374-9924
Practice Address - Fax:773-374-9422
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist