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General NPI Number Information
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NPI Number | 1124423967
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Entity Type | Organization
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Legal Business Name | TQP DENTISTRY PA
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Dates
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Enumeration Date | 10/22/2014
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1909 N MAIN ST STE 107
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City | PEARLAND
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State | TX
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Zip | 77581-3369
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Country | US
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Telephone | 646-305-7069
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Fax |
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Provider Business Mailing Address
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Address Line | 10223 BROADWAY ST STE P-248
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City | PEARLAND
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State | TX
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Zip | 77584-7880
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Country | US
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Telephone | 646-305-7069
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THIEN QUOC PHAM
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Credential | DDS
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Telephone | 646-305-7069
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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 | 23502
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License Number State | TX
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