Provider Demographics
NPI:1437385630
Name:AQUARIUM DENTAL , PLLC
Entity Type:Organization
Organization Name:AQUARIUM DENTAL , PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-568-1270
Mailing Address - Street 1:9404 W SAM HOUSTON PKWY S STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-2054
Mailing Address - Country:US
Mailing Address - Phone:281-568-1270
Mailing Address - Fax:281-568-1603
Practice Address - Street 1:9404 W SAM HOUSTON PKWY S STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-2054
Practice Address - Country:US
Practice Address - Phone:281-568-1270
Practice Address - Fax:281-568-1603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty