Provider Demographics
NPI:1659380335
Name:THAI, UYEN PHUONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:UYEN
Middle Name:PHUONG
Last Name:THAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:THAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3465 W WALNUT ST STE 209
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-7140
Mailing Address - Country:US
Mailing Address - Phone:972-276-5025
Mailing Address - Fax:972-487-1065
Practice Address - Street 1:3465 W WALNUT ST STE 209
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-7140
Practice Address - Country:US
Practice Address - Phone:972-276-5025
Practice Address - Fax:972-487-1065
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX181871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice