Provider Demographics
NPI:1235463191
Name:ADVANCED DENTAL PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:ADVANCED DENTAL PROFESSIONAL ASSOCIATION
Other - Org Name:TRISTAR DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THANG
Authorized Official - Middle Name:CAO
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-455-2424
Mailing Address - Street 1:12445 EAST FWY # 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-5522
Mailing Address - Country:US
Mailing Address - Phone:713-455-2424
Mailing Address - Fax:
Practice Address - Street 1:12445 EAST FWY # 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5522
Practice Address - Country:US
Practice Address - Phone:713-455-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty