Individual
THO C VAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8055 RITCHIE HWY STE 102, PASADENA, MD 21122-1074
(410) 590-6690
(410) 590-1693
Mailing address
600 TECHNOLOGY PARK STE 101, LAKE MARY, FL 32746-7122
(800) 786-1613
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
18078
MD
Other
Enumeration date
05/31/2024
Last updated
05/31/2024
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