MEDICARE: DENTAL TREND P.A.

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	18974	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	983207	OTHER	TX	UNITED CONCORDIA
2	88D356	OTHER	TX	BCBS
3	B-18974-1	OTHER	TX	CHIP

General Provider Information

NPI Number	:	1760607964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL TREND P.A.

Provider Business Mailing Address
First Line	:	12220 JONES RD
Second Line	:	SUITE C
City	:	HOUSTON
State	:	TX
Zip	:	77070-5265
Country	:	US
Telephone Number	:	281-477-7200
Fax Number	:	281-477-7289

Provider Business Practice Location Address
First Line	:	12220 JONES RD
Second Line	:	SUITE C
City	:	HOUSTON
State	:	TX
Zip	:	77070-5265
Country	:	US
Telephone Number	:	281-477-7200
Fax Number	:	281-477-7289

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KIMCUC T. VO
Credential	:	D.D.S.
Telephone Number	:	281-477-7200

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	08/22/2020

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Directions to “DENTAL TREND P.A. ” Practice Location

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