Provider Demographics
NPI:1447428446
Name:DO, PHUONG NAM THI
Entity Type:Individual
Prefix:
First Name:PHUONG NAM
Middle Name:THI
Last Name:DO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10815 BEECHNUT ST STE 131
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-4491
Mailing Address - Country:US
Mailing Address - Phone:281-879-7749
Mailing Address - Fax:281-879-5195
Practice Address - Street 1:10815 BEECHNUT ST STE 131
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-4491
Practice Address - Country:US
Practice Address - Phone:281-879-7749
Practice Address - Fax:281-879-5195
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14490122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist