Provider Demographics
NPI:1467126458
Name:PHO, DANG (DMD)
Entity Type:Individual
Prefix:
First Name:DANG
Middle Name:
Last Name:PHO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W COMMERCE ST APT 395
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-1331
Mailing Address - Country:US
Mailing Address - Phone:713-584-5765
Mailing Address - Fax:
Practice Address - Street 1:411 W COMMERCE ST APT 395
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-1331
Practice Address - Country:US
Practice Address - Phone:713-584-5765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX377031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice