Provider Demographics
NPI:1164634069
Name:HOLLYWOOD CORPORATION
Entity Type:Organization
Organization Name:HOLLYWOOD CORPORATION
Other - Org Name:HOLLYWOOD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VI
Authorized Official - Middle Name:G
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:281-894-7210
Mailing Address - Street 1:9211 WEST ROAD, STE. 151
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064
Mailing Address - Country:US
Mailing Address - Phone:281-894-7210
Mailing Address - Fax:
Practice Address - Street 1:9211 WEST ROAD, STE. 151
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064
Practice Address - Country:US
Practice Address - Phone:281-894-7210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21179261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB2117902OtherTEXAS CHIP