Provider Demographics
NPI:1417491994
Name:AUBURN LAKES PERIODONTICS
Entity Type:Organization
Organization Name:AUBURN LAKES PERIODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THALIDA
Authorized Official - Middle Name:THUY
Authorized Official - Last Name:DONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:832-953-3100
Mailing Address - Street 1:6922 W RAYFORD RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-3003
Mailing Address - Country:US
Mailing Address - Phone:832-953-3100
Mailing Address - Fax:832-953-3101
Practice Address - Street 1:6922 W RAYFORD RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-3003
Practice Address - Country:US
Practice Address - Phone:832-953-3100
Practice Address - Fax:832-953-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-18
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX258631223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty