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General NPI Number Information
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NPI Number | 1023973070
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Entity Type | Organization
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Legal Business Name | TY DENTAL HALTOM CITY PLLC
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 3101 DENTON HWY STE 100
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City | HALTOM CITY
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State | TX
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Zip | 76117-3706
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Country | US
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Telephone | 817-831-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 8150 SPRINGWOOD DR STE 150B
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City | IRVING
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State | TX
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Zip | 75063-5810
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Country | US
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Telephone | 956-507-7253
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIEN PHAN
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Credential | DMD
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Telephone | 408-835-3726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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