Healthcare Provider Details

I. General information

NPI: 1568525665
Provider Name (Legal Business Name): NGA THIEU HUANG D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E MAIN ST STE 102
RICHARDSON TX
75081-6060
US

IV. Provider business mailing address

310 E MAIN ST STE 102
RICHARDSON TX
75081-6060
US

V. Phone/Fax

Practice location:
  • Phone: 972-479-9304
  • Fax:
Mailing address:
  • Phone: 972-479-9304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberTX 15543
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: