Provider Demographics
NPI:1679781066
Name:GREENWAY DENTAL, PA
Entity Type:Organization
Organization Name:GREENWAY DENTAL, PA
Other - Org Name:THE VILLAGE DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINH THU
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-874-1500
Mailing Address - Street 1:2518 TANGLEY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-2516
Mailing Address - Country:US
Mailing Address - Phone:713-874-1500
Mailing Address - Fax:713-874-1555
Practice Address - Street 1:2518 TANGLEY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-2516
Practice Address - Country:US
Practice Address - Phone:713-874-1500
Practice Address - Fax:713-874-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty