Provider Demographics
NPI:1093256893
Name:SAINT PAUL DENTAL PA
Entity Type:Organization
Organization Name:SAINT PAUL DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THUONG
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-583-6919
Mailing Address - Street 1:2260 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ST PAUL
Mailing Address - State:TX
Mailing Address - Zip Code:75098-7799
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2260 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ST PAUL
Practice Address - State:TX
Practice Address - Zip Code:75098-7799
Practice Address - Country:US
Practice Address - Phone:972-473-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty