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General NPI Number Information
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NPI Number | 1912325630
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Entity Type | Organization
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Legal Business Name | AEGEAN LAN PHAMNGUYEN P. A.
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 03/31/2014
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Provider Practice Location Address
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Address Line | 5655 BEECHNUT ST SUITE #17
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City | HOUSTON
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State | TX
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Zip | 77096-1021
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Country | US
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Telephone | 832-465-2381
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Fax |
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Provider Business Mailing Address
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Address Line | 5655 BEECHNUT ST SUITE #17
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City | HOUSTON
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State | TX
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Zip | 77096-1021
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Country | US
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Telephone | 832-465-2381
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. AEGEAN LAN PHAMNGUYEN
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Credential | D.D.S.
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Telephone | 832-465-2381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 27117
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License Number State | TX
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