Provider Demographics
NPI:1033328174
Name:FIESTA DENTISTRY, P.A.
Entity Type:Organization
Organization Name:FIESTA DENTISTRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HIEP
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-670-8922
Mailing Address - Street 1:723A SHOTWELL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77020-4813
Mailing Address - Country:US
Mailing Address - Phone:713-670-8922
Mailing Address - Fax:713-670-7969
Practice Address - Street 1:723A SHOTWELL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77020-4813
Practice Address - Country:US
Practice Address - Phone:713-670-8922
Practice Address - Fax:713-670-7969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154954502Medicaid