Provider Demographics
NPI:1043540305
Name:HIEU T PHAN PC
Entity Type:Organization
Organization Name:HIEU T PHAN PC
Other - Org Name:PIONEER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HIEU
Authorized Official - Middle Name:TAN
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-870-5282
Mailing Address - Street 1:1100 W PIONEER DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-7213
Mailing Address - Country:US
Mailing Address - Phone:972-870-5282
Mailing Address - Fax:
Practice Address - Street 1:1100 W PIONEER DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-7213
Practice Address - Country:US
Practice Address - Phone:972-870-5282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-10
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty