Provider Demographics
NPI:1336134337
Name:MAI, THANH (DDS)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:
Last Name:MAI
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 1:16645 COUNTY ROAD 831
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5079
Mailing Address - Country:US
Mailing Address - Phone:713-703-2915
Mailing Address - Fax:281-489-6763
Practice Address - Street 1:2945 GULF FREEWAY S
Practice Address - Street 2:SUITE D
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573
Practice Address - Country:US
Practice Address - Phone:281-534-7300
Practice Address - Fax:281-534-7299
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice