Provider Demographics
NPI:1467118182
Name:PHANTASTIC DENTAL CARE PA
Entity Type:Organization
Organization Name:PHANTASTIC DENTAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MINH
Authorized Official - Middle Name:HONG
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-944-8008
Mailing Address - Street 1:102 FAIRMONT PKWY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2742
Mailing Address - Country:US
Mailing Address - Phone:713-944-8008
Mailing Address - Fax:713-485-5020
Practice Address - Street 1:1705 CLINTON DR
Practice Address - Street 2:
Practice Address - City:GALENA PARK
Practice Address - State:TX
Practice Address - Zip Code:77547-3224
Practice Address - Country:US
Practice Address - Phone:713-944-8008
Practice Address - Fax:713-485-5020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty