MEDICARE: HEALTHY DENTAL, 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
1	1223G0001X	General Practice Dentistry	22365	TX

General Provider Information

NPI Number	:	1932399474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY DENTAL, PA

Provider Business Mailing Address
First Line	:	16506 FM 529 RD
Second Line	:	SUITE 117
City	:	HOUSTON
State	:	TX
Zip	:	77095-1416
Country	:	US
Telephone Number	:	281-656-2500
Fax Number	:	281-656-2518

Provider Business Practice Location Address
First Line	:	16506 FM 529 RD
Second Line	:	SUITE 117
City	:	HOUSTON
State	:	TX
Zip	:	77095-1416
Country	:	US
Telephone Number	:	281-656-2500
Fax Number	:	281-656-2518

Authorized Official
Title or Position	:	PRESIDENT OF HEALTHY DENTAL, PA
Name	:	THANH-HANG THI PHAN
Credential	:	D.D.S.
Telephone Number	:	281-656-2500

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

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