MEDICARE: ACCESS DENTAL OF WEBB CHAPEL

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

General Provider Information

NPI Number	:	1891939047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS DENTAL OF WEBB CHAPEL

Provider Business Mailing Address
First Line	:	10909 WEBB CHAPEL RD
Second Line	:	SUITE #121
City	:	DALLAS
State	:	TX
Zip	:	75229-3739
Country	:	US
Telephone Number	:	214-357-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	10909 WEBB CHAPEL RD
Second Line	:	SUITE #121
City	:	DALLAS
State	:	TX
Zip	:	75229-3739
Country	:	US
Telephone Number	:	214-357-6500
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TIEN DINH PHAN
Credential	:	DMD
Telephone Number	:	682-365-9115

Provider Enumeration Date	:	04/30/2009
Last Update Date	:	04/30/2009

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