Provider Demographics
NPI:1346226552
Name:TRIEU, THI BA (DMD)
Entity type:Individual
Prefix:DR
First Name:THI BA
Middle Name:
Last Name:TRIEU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 W CHEW AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2355
Mailing Address - Country:US
Mailing Address - Phone:215-549-4888
Mailing Address - Fax:215-549-4888
Practice Address - Street 1:437 W CHEW AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-2355
Practice Address - Country:US
Practice Address - Phone:215-549-4888
Practice Address - Fax:215-549-4888
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 026834L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice