MEDICARE: ANDREW PHAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	33988	TX

General Provider Information

NPI Number	:	1225521966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW PHAN DDS

Provider Business Mailing Address
First Line	:	2900 N BRAESWOOD BLVD APT 3308
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-2372
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12168 BELLAIRE BLVD STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-2642
Country	:	US
Telephone Number	:	281-400-1111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2018
Last Update Date	:	06/07/2018

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Directions to “ ANDREW PHAN DDS” Practice Location

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