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General NPI Number Information
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NPI Number | 1811378466
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Entity Type | Organization
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Legal Business Name | RADIANT DENTAL - WESTCHASE
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Dates
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Enumeration Date | 06/09/2015
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 3730 S. GESSNER RD. C-100
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City | HOUSTON
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State | TX
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Zip | 77063
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Country | US
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Telephone | 832-834-5544
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Fax | 832-834-5590
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Provider Business Mailing Address
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Address Line | 3730 S. GESSNER RD C-100
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City | HOUSTON
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State | TX
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Zip | 77063
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Country | US
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Telephone | 832-834-5544
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Fax | 832-834-5590
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. THUY NGOC NGO
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Credential | DMD
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Telephone | 832-419-0918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 23389
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License Number State | TX
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