Provider Demographics
NPI:1235418880
Name:PHAN, HOA TUYET (DDS)
Entity Type:Individual
Prefix:
First Name:HOA
Middle Name:TUYET
Last Name:PHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5892B EASTEX FWY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708-4824
Mailing Address - Country:US
Mailing Address - Phone:409-892-2991
Mailing Address - Fax:409-892-2154
Practice Address - Street 1:5892B EASTEX FWY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708-4824
Practice Address - Country:US
Practice Address - Phone:409-892-2991
Practice Address - Fax:409-892-2154
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27325122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist