Provider Demographics
NPI:1871717645
Name:DO, LONG VUONG (DDS)
Entity type:Individual
Prefix:
First Name:LONG
Middle Name:VUONG
Last Name:DO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4706 AUTUMN PINE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7165
Mailing Address - Country:US
Mailing Address - Phone:832-512-9219
Mailing Address - Fax:
Practice Address - Street 1:7955 BARKER CYPRESS
Practice Address - Street 2:ST #1000
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433
Practice Address - Country:US
Practice Address - Phone:832-512-9219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173779301Medicaid
TXG6012001OtherTEXAS CHIP