Provider Demographics
NPI:1568813186
Name:AUTUMN FAMILY DENTISTRY, P.L.L.C.
Entity Type:Organization
Organization Name:AUTUMN FAMILY DENTISTRY, P.L.L.C.
Other - Org Name:AUTUMN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THIEN-KIM
Authorized Official - Middle Name:THI
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-678-8344
Mailing Address - Street 1:2508 GULF FWY S STE 108
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6743
Mailing Address - Country:US
Mailing Address - Phone:281-678-8344
Mailing Address - Fax:
Practice Address - Street 1:2508 GULF FWY S STE 108
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6743
Practice Address - Country:US
Practice Address - Phone:281-678-8344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty