Provider Demographics
NPI:1568015063
Name:PHO, JIMMY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:D
Last Name:PHO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16010 SANDY RING CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-3899
Mailing Address - Country:US
Mailing Address - Phone:832-856-0626
Mailing Address - Fax:
Practice Address - Street 1:503 MAXEY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77013-5019
Practice Address - Country:US
Practice Address - Phone:832-358-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX355371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice