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General NPI Number Information
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NPI Number | 1912175654
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Entity Type | Organization
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Legal Business Name | 812 TOOTH CARE CORPORATION
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 727B W DAVIS ST
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City | CONROE
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State | TX
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Zip | 77301-2704
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Country | US
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Telephone | 936-760-2555
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Fax | 936-760-2557
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Provider Business Mailing Address
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Address Line | 727B W DAVIS ST
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City | CONROE
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State | TX
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Zip | 77301-2704
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Country | US
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Telephone | 936-760-2555
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Fax | 936-760-2557
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Authorized Official
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Title or Position | DENTIST
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Name | DR. LINH NGUYEN
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Credential |
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Telephone | 936-760-2555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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