Provider Demographics
NPI:1811244627
Name:VAN-DINH, KIM-THI (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:KIM-THI
Middle Name:
Last Name:VAN-DINH
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 CANTERBURY RD
Mailing Address - Street 2:UNIT 407
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2370
Mailing Address - Country:US
Mailing Address - Phone:408-891-1289
Mailing Address - Fax:
Practice Address - Street 1:3801 CANTERBURY RD
Practice Address - Street 2:UNIT 407
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2370
Practice Address - Country:US
Practice Address - Phone:408-891-1289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD150581223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics