Provider Demographics
NPI:1417184763
Name:NGO, PHUONG LAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:LAN
Last Name:NGO
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 1:3306 OWENS BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3030
Mailing Address - Country:US
Mailing Address - Phone:214-926-1290
Mailing Address - Fax:
Practice Address - Street 1:3443 W CAMPBELL RD
Practice Address - Street 2:STE 650
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-8145
Practice Address - Country:US
Practice Address - Phone:972-414-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-14
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist