Provider Demographics
NPI:1558420794
Name:ADVANCE DENTISTRY, P.A
Entity Type:Organization
Organization Name:ADVANCE DENTISTRY, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:HANG
Authorized Official - Last Name:TO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-464-4774
Mailing Address - Street 1:10128 HAMMERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-5010
Mailing Address - Country:US
Mailing Address - Phone:713-464-4774
Mailing Address - Fax:713-464-6776
Practice Address - Street 1:10128 HAMMERLY BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-5010
Practice Address - Country:US
Practice Address - Phone:713-464-4774
Practice Address - Fax:713-464-6776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130704301Medicaid