Provider Demographics
NPI:1073933750
Name:PARK CITIES ORTHODONTICS PA
Entity Type:Organization
Organization Name:PARK CITIES ORTHODONTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIEN
Authorized Official - Middle Name:THI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:214-484-8488
Mailing Address - Street 1:8611 HILLCREST AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-4207
Mailing Address - Country:US
Mailing Address - Phone:214-484-8488
Mailing Address - Fax:214-484-8497
Practice Address - Street 1:8611 HILLCREST AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-4207
Practice Address - Country:US
Practice Address - Phone:214-484-8488
Practice Address - Fax:214-484-8497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1063719953OtherNATIONAL PLAN & PROVIDER ENUMERATION SYSTEM