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NPI Code Detail

MEDICARE: LA COSTA DENTAL OF AYERS PA

MEDICARE: LA COSTA DENTAL OF AYERS PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist22334TX

General Provider Information

NPI Number : 1700204252
Entity Type Code : Organization
Provider Name (Legal Business Name) : LA COSTA DENTAL OF AYERS PA
Provider Business Mailing Address
First Line : 8150 SPRINGWOOD DR # 150B
Second Line :
City : IRVING
State : TX
Zip : 75063-5810
Country : US
Telephone Number : 956-507-7253
Fax Number :
Provider Business Practice Location Address
First Line : 4224 AYERS ST
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78415-5317
Country : US
Telephone Number : 817-531-3500
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : MR. TIEN DINH PHAN
Credential : DMD
Telephone Number : 817-531-3500
Provider Enumeration Date : 04/02/2014
Last Update Date : 12/29/2025

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Directions to “LA COSTA DENTAL OF AYERS PA ” Practice Location

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