MEDICARE: GOLDEN FULTON DENTAL

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	208D00000X	General Practice Physician	19895	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B1989503	OTHER	TX	DELTA DENTAL CA, CHIPS

General Provider Information

NPI Number	:	1649269127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN FULTON DENTAL

Provider Business Mailing Address
First Line	:	7700 FULTON ST STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3642
Country	:	US
Telephone Number	:	713-697-0604
Fax Number	:	713-697-1303

Provider Business Practice Location Address
First Line	:	7700 FULTON ST STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3642
Country	:	US
Telephone Number	:	713-697-0604
Fax Number	:	713-697-1303

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HIEU QUANG HUYNH
Credential	:
Telephone Number	:	832-488-2775

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	03/23/2009

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Directions to “GOLDEN FULTON DENTAL ” Practice Location

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