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NPI Code Detail

MEDICARE: SOUTH HOUSTON FAMILY DENTAL PC

MEDICARE: SOUTH HOUSTON FAMILY DENTAL PC
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
1122300000XDentist28405TX

General Provider Information

NPI Number : 1659814820
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH HOUSTON FAMILY DENTAL PC
Provider Business Mailing Address
First Line : 701 COLLEGE AVE
Second Line :
City : SOUTH HOUSTON
State : TX
Zip : 77587-4205
Country : US
Telephone Number : 713-261-8311
Fax Number :
Provider Business Practice Location Address
First Line : 701 COLLEGE AVE
Second Line :
City : SOUTH HOUSTON
State : TX
Zip : 77587-4205
Country : US
Telephone Number : 713-261-8311
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ANH PHAM
Credential : DDS
Telephone Number : 713-261-8311
Provider Enumeration Date : 11/21/2016
Last Update Date : 11/21/2016

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Directions to “SOUTH HOUSTON FAMILY DENTAL PC ” Practice Location

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