MEDICARE: HA PHAN HO D.D.S., M.M.SC.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	17144	TX

General Provider Information

NPI Number	:	1508054180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HA PHAN HO D.D.S., M.M.SC.

Provider Business Mailing Address
First Line	:	9127 KATY FWY
Second Line	:	200
City	:	HOUSTON
State	:	TX
Zip	:	77024-1642
Country	:	US
Telephone Number	:	713-468-1717
Fax Number	:	713-468-7566

Provider Business Practice Location Address
First Line	:	9127 KATY FWY
Second Line	:	200
City	:	HOUSTON
State	:	TX
Zip	:	77024-1642
Country	:	US
Telephone Number	:	713-468-1717
Fax Number	:	713-468-7566

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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