Healthcare Provider Details

I. General information

NPI: 1386201366
Provider Name (Legal Business Name): TNN DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23896 TX-494 LOOP
PORTER TX
77365
US

IV. Provider business mailing address

5547 HIGHWAY 6 N
HOUSTON TX
77084-1827
US

V. Phone/Fax

Practice location:
  • Phone: 408-616-9175
  • Fax:
Mailing address:
  • Phone: 408-616-9175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HIEU TIN NGUYEN PHAM
Title or Position: DENTIST-OWNER
Credential: DDS
Phone: 408-616-9175