Provider Demographics
NPI:1639393804
Name:MINH PHAN DDS PA
Entity Type:Organization
Organization Name:MINH PHAN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MINH
Authorized Official - Middle Name:H
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-473-7223
Mailing Address - Street 1:905 SOUTHMORE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502
Mailing Address - Country:US
Mailing Address - Phone:713-473-7223
Mailing Address - Fax:713-473-7206
Practice Address - Street 1:1705 CLINTON DRIVE
Practice Address - Street 2:
Practice Address - City:GALENA PARK
Practice Address - State:TX
Practice Address - Zip Code:77547
Practice Address - Country:US
Practice Address - Phone:713-672-4779
Practice Address - Fax:713-672-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG6010103OtherDELTA DENTAL