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General NPI Number Information
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NPI Number | 1285873232
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Entity Type | Organization
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Legal Business Name | LAMAR DENTAL CENTER
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Dates
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Enumeration Date | 02/16/2009
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Last Update Date | 02/16/2009
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Provider Practice Location Address
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Address Line | 9616 N LAMAR BLVD STE 162
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City | AUSTIN
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State | TX
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Zip | 78753-4152
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Country | US
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Telephone | 512-836-6385
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Fax |
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Provider Business Mailing Address
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Address Line | 9616 N LAMAR BLVD STE 162
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City | AUSTIN
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State | TX
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Zip | 78753-4152
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Country | US
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Telephone | 512-836-6385
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHUONG NGUYEN
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Credential | D,D,S
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Telephone | 512-626-7735
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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 | 20457
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License Number State | TX
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