Provider Demographics
NPI:1356851968
Name:FAIRFIELD DENTISTRY PLLC
Entity Type:Organization
Organization Name:FAIRFIELD DENTISTRY PLLC
Other - Org Name:EMERALD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DENTAL PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:QUYNH
Authorized Official - Middle Name:LAN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:281-373-4000
Mailing Address - Street 1:28070 HIGHWAY 290 STE 150
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-6921
Mailing Address - Country:US
Mailing Address - Phone:281-373-4000
Mailing Address - Fax:281-373-4011
Practice Address - Street 1:28070 HIGHWAY 290 STE 150
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-6921
Practice Address - Country:US
Practice Address - Phone:281-373-4000
Practice Address - Fax:281-373-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX263471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty