Provider Demographics
NPI:1083337356
Name:TAN NGO DDS PLLC
Entity Type:Organization
Organization Name:TAN NGO DDS PLLC
Other - Org Name:SMILES OF FULSHEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-789-1455
Mailing Address - Street 1:6520 FM 359 SOUTH SUITE 200
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441
Mailing Address - Country:US
Mailing Address - Phone:832-789-1455
Mailing Address - Fax:832-789-1456
Practice Address - Street 1:6520 FM 359 SOUTH
Practice Address - Street 2:SUITE 200
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441
Practice Address - Country:US
Practice Address - Phone:832-789-1455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty