Basic Information
| Provider Information | |||||||||
| NPI: | 1700927944 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAI | ||||||||
| FirstName: | THUY | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2727 PLEASANT VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366062162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514735705 | ||||||||
| FaxNumber: | 2514794709 | ||||||||
| Practice Location | |||||||||
| Address1: | 2727 PLEASANT VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366062162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514735705 | ||||||||
| FaxNumber: | 2514794709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 5386 | AL | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 51524786 | 01 | AL | AL BLUE CROSS BLUE SHIELD | OTHER |