=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699861153
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APHADO ORTHODONTICS, L.P.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 02/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 739 JAMES ST
-----------------------------------------------------
City | TOMBALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77375-4549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-255-6911
-----------------------------------------------------
Fax | 281-220-6425
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 739 JAMES ST
-----------------------------------------------------
City | TOMBALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77375-4549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-255-6911
-----------------------------------------------------
Fax | 281-220-6425
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HANH DIEM-CHAU DOAN
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 281-255-6911
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 22582
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 22582
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------