Provider Demographics
NPI:1578891354
Name:RADIANT DENTAL PA
Entity Type:Organization
Organization Name:RADIANT DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THUY
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:832-419-0918
Mailing Address - Street 1:9325 KEMPWOOD DR
Mailing Address - Street 2:SUITE #A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-2824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9325 KEMPWOOD DR
Practice Address - Street 2:SUITE #A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-2824
Practice Address - Country:US
Practice Address - Phone:832-419-0918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty