Individual
VU DANG LA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
240 S 40TH ST, PHILADELPHIA, PA 19104-6030
(215) 573-6112
Mailing address
240 S 40TH ST, PHILADELPHIA, PA 19104-6030
(215) 573-6112
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401415054
VA
1223P0300X
Periodontics
Primary
RFD000016
PA
Other
Enumeration date
12/22/2015
Last updated
12/22/2015
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