Provider Demographics
NPI:1912144114
Name:TOM VU DENTAL CORP
Entity Type:Organization
Organization Name:TOM VU DENTAL CORP
Other - Org Name:SURF CITY DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:T
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-357-9958
Mailing Address - Street 1:7171 WARNER AVE
Mailing Address - Street 2:SUITE #C
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5478
Mailing Address - Country:US
Mailing Address - Phone:714-842-7000
Mailing Address - Fax:714-842-7311
Practice Address - Street 1:7171 WARNER AVE
Practice Address - Street 2:SUITE #C
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5478
Practice Address - Country:US
Practice Address - Phone:714-842-7000
Practice Address - Fax:714-842-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-10
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization