Provider Demographics
NPI:1538206149
Name:VAN, ADRIENNE NGOCLAN (DDS)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:NGOCLAN
Last Name:VAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LAN
Other - Middle Name:NGOCTHI
Other - Last Name:VAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3325 VILLA CONTESSA CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1770
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2114 SENTER RD
Practice Address - Street 2:SUITE 14
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2608
Practice Address - Country:US
Practice Address - Phone:408-298-8187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice