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General NPI Number Information
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NPI Number | 1568616779
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Entity Type | Organization
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Legal Business Name | DENTAL GROUP, P.C.
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Dates
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Enumeration Date | 11/14/2008
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Last Update Date | 11/14/2008
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Provider Practice Location Address
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Address Line | 5934 BROADWAY ST
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City | GALVESTON
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State | TX
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Zip | 77551-4305
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Country | US
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Telephone | 409-740-7744
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Fax | 409-744-4541
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Provider Business Mailing Address
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Address Line | 5934 BROADWAY ST
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City | GALVESTON
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State | TX
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Zip | 77551-4305
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Country | US
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Telephone | 409-740-7744
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Fax | 409-744-4541
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Authorized Official
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Title or Position | PRINCIPAL
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Name | DR. THUY THOMAS TRAN
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Credential | DDS
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Telephone | 409-740-7744
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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 | 0021051
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License Number State | TX
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