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General NPI Number Information
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NPI Number | 1205019478
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Entity Type | Organization
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Legal Business Name | GALENA PARK DENTAL
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 1705 CLINTON DR
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City | GALENA PARK
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State | TX
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Zip | 77547-3224
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Country | US
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Telephone | 713-672-4479
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Fax |
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Provider Business Mailing Address
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Address Line | 1705 CLINTON DR
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City | GALENA PARK
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State | TX
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Zip | 77547-3224
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | MARY N PHAN
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Credential |
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Telephone | 713-672-4779
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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 | 22483
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License Number State | TX
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