Provider Demographics
NPI:1306008073
Name:VO, PHUONG LY (DDS)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:LY
Last Name:VO
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 1:2466 HIGHWAY 6 S
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-5251
Mailing Address - Country:US
Mailing Address - Phone:281-556-8400
Mailing Address - Fax:281-556-8430
Practice Address - Street 1:2466 HIGHWAY 6 S
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5251
Practice Address - Country:US
Practice Address - Phone:281-556-8400
Practice Address - Fax:281-556-8430
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161438001Medicaid