Provider Demographics
NPI:1134312481
Name:TRAN, MIMI PHUONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIMI PHUONG
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:MIMI
Other - Middle Name:
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:11803 WESTHEIMER RD
Mailing Address - Street 2:SUITE 710
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-6795
Mailing Address - Country:US
Mailing Address - Phone:281-497-7911
Mailing Address - Fax:
Practice Address - Street 1:11803 WESTHEIMER RD
Practice Address - Street 2:SUITE 710
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-6795
Practice Address - Country:US
Practice Address - Phone:281-497-7911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice