Healthcare Provider Details

I. General information

NPI: 1801347125
Provider Name (Legal Business Name): SD-933SCHERTZ PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 FM 3009
SCHERTZ TX
78154-1000
US

IV. Provider business mailing address

10901 GARLAND RD
DALLAS TX
75218-2613
US

V. Phone/Fax

Practice location:
  • Phone: 210-659-2200
  • Fax: 210-566-1136
Mailing address:
  • Phone: 214-466-1400
  • Fax: 214-367-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19887
License Number StateTX

VIII. Authorized Official

Name: LYNHTHY THY PHAM
Title or Position: PRESIDENT
Credential: DDS
Phone: 214-466-1400