Provider Demographics
NPI:1285870394
Name:VU, HUONG T (DDS)
Entity type:Individual
Prefix:
First Name:HUONG
Middle Name:T
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 1:4745 STATESMEN DR STE E
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-5649
Mailing Address - Country:US
Mailing Address - Phone:317-643-7117
Mailing Address - Fax:317-643-7112
Practice Address - Street 1:4745 STATESMEN DR STE E
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250
Practice Address - Country:US
Practice Address - Phone:317-643-7117
Practice Address - Fax:317-643-7112
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011252A122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12011252AOtherIN DENTAL LICENSE