Healthcare Provider Details

I. General information

NPI: 1457937617
Provider Name (Legal Business Name): WOW SMILES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13420 TOMBALL PKWY STE B
HOUSTON TX
77086-3167
US

IV. Provider business mailing address

13420 TOMBALL PKWY STE B
HOUSTON TX
77086-3167
US

V. Phone/Fax

Practice location:
  • Phone: 713-368-9540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. XUAN QUYEN TRUONG
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 713-367-9540