Provider Demographics
NPI:1114917846
Name:ATLAS DENTAL LP
Entity Type:Organization
Organization Name:ATLAS DENTAL LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:QUANG
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-233-1581
Mailing Address - Street 1:14520 MEMORIAL DR
Mailing Address - Street 2:M144
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-5434
Mailing Address - Country:US
Mailing Address - Phone:979-233-1581
Mailing Address - Fax:979-233-8355
Practice Address - Street 1:1723 N AVENUE K
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:TX
Practice Address - Zip Code:77541-3605
Practice Address - Country:US
Practice Address - Phone:979-233-1581
Practice Address - Fax:979-233-8355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162592301Medicaid