Provider Demographics
NPI:1609152727
Name:KARSIL DENTAL PROFESSIONALS, PA
Entity Type:Organization
Organization Name:KARSIL DENTAL PROFESSIONALS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NGHI
Authorized Official - Middle Name:
Authorized Official - Last Name:TRINH-PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-485-6088
Mailing Address - Street 1:8703 BROADWAY ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8167
Mailing Address - Country:US
Mailing Address - Phone:281-485-6088
Mailing Address - Fax:281-485-1773
Practice Address - Street 1:8703 BROADWAY ST
Practice Address - Street 2:SUITE 125
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8167
Practice Address - Country:US
Practice Address - Phone:281-485-6088
Practice Address - Fax:281-485-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18162122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183491301Medicaid