Provider Demographics
NPI:1659150811
Name:PHAN, CATHERINE (DMD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9515 BROADWAY ST STE 117
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-6200
Mailing Address - Country:US
Mailing Address - Phone:281-997-2900
Mailing Address - Fax:
Practice Address - Street 1:9515 BROADWAY ST STE 117
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-6200
Practice Address - Country:US
Practice Address - Phone:281-997-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40063122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist