Healthcare Provider Details

I. General information

NPI: 1891453718
Provider Name (Legal Business Name): TPHAN DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 UNIVERSITY BLVD STE 400
ROUND ROCK TX
78665-1068
US

IV. Provider business mailing address

581 UNIVERSITY BLVD STE 400
ROUND ROCK TX
78665-1068
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-3333
  • Fax:
Mailing address:
  • Phone: 512-244-3333
  • 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: TRUNG PHAN
Title or Position: OWNER
Credential: DDS
Phone: 703-608-3760