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General NPI Number Information
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NPI Number | 1124458732
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Entity Type | Organization
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Legal Business Name | TID DENTAL PLLC
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Dates
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Enumeration Date | 11/18/2013
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Last Update Date | 11/21/2013
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Provider Practice Location Address
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Address Line | 9417 MESA DRIVE #A
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City | HOUSTON
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State | TX
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Zip | 77028-1253
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Country | US
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Telephone | 281-661-6611
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Fax | 281-661-6615
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Provider Business Mailing Address
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Address Line | PO BOX 909
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City | ALIEF
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State | TX
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Zip | 77411-0909
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Country | US
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Telephone | 281-661-6611
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Fax | 281-661-6615
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Authorized Official
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Title or Position | OWNER
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Name | DR. HUYNH HOA NGUYEN
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Credential |
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Telephone | 469-446-3833
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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 | 24610
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License Number State | TX
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