Provider Demographics
NPI:1275944753
Name:CEDAR PARK DENTAL CORPORATION
Entity Type:Organization
Organization Name:CEDAR PARK DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DZUNG
Authorized Official - Middle Name:HUU HOANG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-260-8556
Mailing Address - Street 1:601 E WHITESTONE BLVD STE 628
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-9047
Mailing Address - Country:US
Mailing Address - Phone:512-260-8556
Mailing Address - Fax:
Practice Address - Street 1:601 E WHITESTONE BLVD STE 628
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-9047
Practice Address - Country:US
Practice Address - Phone:512-260-8556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26448261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental