Individual
QUY CONG VAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
940 CHURCH RD W, SOUTHAVEN, MS 38671-9611
(662) 253-8027
Mailing address
1195 HARBOR RIVER DR, MEMPHIS, TN 38103-8973
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4395-23
MS
Other
Enumeration date
06/21/2023
Last updated
06/21/2023
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