Provider Demographics
NPI:1407229214
Name:GREEN EARTH DENTISTRY, PA
Entity Type:Organization
Organization Name:GREEN EARTH DENTISTRY, PA
Other - Org Name:GREEN EARTH DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NGUYET
Authorized Official - Middle Name:
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-523-3264
Mailing Address - Street 1:1202 ELGIN ST
Mailing Address - Street 2:A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-2829
Mailing Address - Country:US
Mailing Address - Phone:713-523-3264
Mailing Address - Fax:
Practice Address - Street 1:1202 ELGIN ST
Practice Address - Street 2:A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-2829
Practice Address - Country:US
Practice Address - Phone:713-523-3264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX271161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1952699936OtherINDIVIDUAL