Provider Demographics
NPI:1093196644
Name:NORTHWEST DENTAL ASSOCIATES P.A.
Entity Type:Organization
Organization Name:NORTHWEST DENTAL ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOAI
Authorized Official - Middle Name:C
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-219-7484
Mailing Address - Street 1:11066 PECAN PARK BLVD.
Mailing Address - Street 2:SUITE #411
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613
Mailing Address - Country:US
Mailing Address - Phone:512-219-7484
Mailing Address - Fax:512-219-6505
Practice Address - Street 1:11066 PECAN PARK BLVD.
Practice Address - Street 2:SUITE #411
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-219-7484
Practice Address - Fax:512-219-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty