MEDICARE: MINH PHAN DDS PA

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	19016	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G6010103	OTHER	TX	DELTA DENTAL

General Provider Information

NPI Number	:	1639393804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINH PHAN DDS PA

Provider Business Mailing Address
First Line	:	905 SOUTHMORE
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77502
Country	:	US
Telephone Number	:	713-473-7223
Fax Number	:	713-473-7206

Provider Business Practice Location Address
First Line	:	1705 CLINTON DRIVE
Second Line	:
City	:	GALENA PARK
State	:	TX
Zip	:	77547
Country	:	US
Telephone Number	:	713-672-4779
Fax Number	:	713-672-5070

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MINH H PHAN
Credential	:
Telephone Number	:	713-473-7223

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	08/22/2020

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Directions to “MINH PHAN DDS PA ” Practice Location

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