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General NPI Number Information
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NPI Number | 1114917846
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Entity Type | Organization
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Legal Business Name | ATLAS DENTAL LP
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 04/29/2011
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Provider Practice Location Address
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Address Line | 1723 N AVENUE K
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City | FREEPORT
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State | TX
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Zip | 77541-3605
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Country | US
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Telephone | 979-233-1581
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Fax | 979-233-8355
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Provider Business Mailing Address
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Address Line | 14520 MEMORIAL DR M144
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City | HOUSTON
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State | TX
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Zip | 77079-5434
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Country | US
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Telephone | 979-233-1581
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Fax | 979-233-8355
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Authorized Official
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Title or Position | PARTNER
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Name | MR. TOM QUANG HUYNH
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Credential |
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Telephone | 979-233-1581
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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 | 19895
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License Number State | TX
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