Provider Demographics
NPI:1235360611
Name:HATHUC, NGUYEN BAO (DDS)
Entity Type:Individual
Prefix:DR
First Name:NGUYEN
Middle Name:BAO
Last Name:HATHUC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28010 HOLLYFARE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5144
Mailing Address - Country:US
Mailing Address - Phone:713-670-6116
Mailing Address - Fax:
Practice Address - Street 1:462 S MASON RD STE 200
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2450
Practice Address - Country:US
Practice Address - Phone:281-395-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58539122300000X
TX249251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist