MEDICARE: MR. PHONG QUOC DUONG D.D.S.

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
1	1223G0001X	General Practice Dentistry	20629	TX

General Provider Information

NPI Number	:	1801933387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHONG QUOC DUONG D.D.S.

Provider Business Mailing Address
First Line	:	11210 VETERANS MEMORIAL
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77067-3758
Country	:	US
Telephone Number	:	281-447-1223
Fax Number	:	281-447-8070

Provider Business Practice Location Address
First Line	:	11210 VETERANS MEMORIAL DR.
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77067-3758
Country	:	US
Telephone Number	:	281-447-1223
Fax Number	:	281-447-8070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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