=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780039933
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HUEY-WEN TSO DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2016
-----------------------------------------------------
Last Update Date | 07/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3030 LBJ FWY STE 1400
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75234-2766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-663-5361
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7177 159TH ST APT 401
-----------------------------------------------------
City | FRESH MEADOWS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11365-4502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-291-5617
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 35474
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------