Provider Demographics
NPI:1477711430
Name:VAN THO DENTAL CENTER
Entity Type:Organization
Organization Name:VAN THO DENTAL CENTER
Other - Org Name:PETER N. VAN THO, D.D.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:NGUYEN
Authorized Official - Last Name:VAN THO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-561-7800
Mailing Address - Street 1:12002 VETERANS MEMORIAL DR
Mailing Address - Street 2:#B3
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-1161
Mailing Address - Country:US
Mailing Address - Phone:281-580-7446
Mailing Address - Fax:281-580-7520
Practice Address - Street 1:12002 VETERANS MEMORIAL DR
Practice Address - Street 2:#B3
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-1161
Practice Address - Country:US
Practice Address - Phone:281-580-7446
Practice Address - Fax:281-580-7520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17169122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1568526531Medicaid
TX1295802734Medicaid