Provider Demographics
NPI:1528473386
Name:VU, KEVIN HIEU (DDS, MS, CDT)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:HIEU
Last Name:VU
Suffix:
Gender:M
Credentials:DDS, MS, CDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 BALD EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4138
Mailing Address - Country:US
Mailing Address - Phone:225-636-0024
Mailing Address - Fax:
Practice Address - Street 1:301 EAST HWY 377 STE 100
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1201
Practice Address - Country:US
Practice Address - Phone:817-579-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6453122300000X
TX333311223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentist