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General NPI Number Information
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NPI Number | 1689949000
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Entity Type | Organization
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Legal Business Name | HEALTHY SMILE DENTAL, PA
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Dates
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Enumeration Date | 03/19/2012
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 20300 FRANZ RD SUITE #1
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City | KATY
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State | TX
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Zip | 77449-5600
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Country | US
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Telephone | 832-321-4210
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Fax | 832-321-4392
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Provider Business Mailing Address
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Address Line | 20300 FRANZ RD STE 1
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City | KATY
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State | TX
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Zip | 77449-5600
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Country | US
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Telephone | 832-321-4210
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF HEALTHY SMILE DENTAL
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Name | DR. THANHHANG THI PHAN
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Credential | DDS
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Telephone | 832-330-0324
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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 | 22365
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License Number State | TX
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