=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831602432
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TUN & ASSOCIATES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2017
-----------------------------------------------------
Last Update Date | 11/06/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25219 KUYKENDAHL RD STE 230
-----------------------------------------------------
City | TOMBALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77375-3350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-843-4150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 218 BIRCH HILL DR
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77479-5016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-535-1774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER ORTHODONTIST
-----------------------------------------------------
Name | DR. WINT WINT TUN
-----------------------------------------------------
Credential | DDS, MS
-----------------------------------------------------
Telephone | 214-535-1774
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 32296
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------