=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124312293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEARE DDS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2011
-----------------------------------------------------
Last Update Date | 06/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10550 W BELLFORT ST SUITE #140
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77031-1934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-530-7330
-----------------------------------------------------
Fax | 281-530-9262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10550 W BELLFORT ST SUITE #140
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77031-1934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-530-7330
-----------------------------------------------------
Fax | 281-530-9262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | KHANH NGUYEN
-----------------------------------------------------
Credential | D.D.S
-----------------------------------------------------
Telephone | 214-909-4443
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 23255
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------