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General NPI Number Information
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NPI Number | 1033314836
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Entity Type | Organization
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Legal Business Name | PRODENT GROUP, PA
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8518 JENSEN DR
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City | HOUSTON
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State | TX
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Zip | 77093-7510
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Country | US
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Telephone | 713-697-8998
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Fax | 713-697-8980
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Provider Business Mailing Address
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Address Line | 8518 JENSEN DR
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City | HOUSTON
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State | TX
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Zip | 77093-7510
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Country | US
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Telephone | 713-697-8998
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Fax | 713-697-8980
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. YEN KIEU CUNG
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Credential | DMD
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Telephone | 713-697-8998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | TX
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