Provider Demographics
NPI:1417307943
Name:NOUVELLE DENTS PA
Entity Type:Organization
Organization Name:NOUVELLE DENTS PA
Other - Org Name:BROADWAY SMILE DESIGNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-643-7673
Mailing Address - Street 1:4025 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-4703
Mailing Address - Country:US
Mailing Address - Phone:731-643-7673
Mailing Address - Fax:713-643-5534
Practice Address - Street 1:4025 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-4703
Practice Address - Country:US
Practice Address - Phone:731-643-7673
Practice Address - Fax:713-643-5534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty