Healthcare Provider Details

I. General information

NPI: 1689683963
Provider Name (Legal Business Name): THUC M LA DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 BELLAIRE BLVD STE# A-18
HOUSTON TX
77072-2544
US

IV. Provider business mailing address

11201 BELLAIRE BLVD STE# A-18
HOUSTON TX
77072-2544
US

V. Phone/Fax

Practice location:
  • Phone: 281-568-8200
  • Fax: 281-568-8884
Mailing address:
  • Phone: 281-568-8200
  • Fax: 281-568-8884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19080
License Number StateTX

VIII. Authorized Official

Name: DR. THUC M LA
Title or Position: PRESIDENT
Credential: DDS
Phone: 281-568-8200