Provider Demographics
NPI:1780790832
Name:VO, NICHOLAS NGHI (DMD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:NGHI
Last Name:VO
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 1:500 S BROAD ST
Mailing Address - Street 2:DENTAL SUITE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1613
Mailing Address - Country:US
Mailing Address - Phone:215-985-6768
Mailing Address - Fax:215-685-6891
Practice Address - Street 1:1720 S BROAD ST
Practice Address - Street 2:HEALTH CENTER #2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2315
Practice Address - Country:US
Practice Address - Phone:215-685-1810
Practice Address - Fax:215-683-1815
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029588Y122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU64459Medicare UPIN