Provider Demographics
NPI:1689835399
Name:PHAN, TRUC THANH (DDS)
Entity Type:Individual
Prefix:
First Name:TRUC
Middle Name:THANH
Last Name:PHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 E ARAPAHO RD
Mailing Address - Street 2:STE 140
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3186
Mailing Address - Country:US
Mailing Address - Phone:469-358-1868
Mailing Address - Fax:972-231-8706
Practice Address - Street 1:2141 E ARAPAHO RD STE 140
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-3186
Practice Address - Country:US
Practice Address - Phone:972-231-8700
Practice Address - Fax:972-231-8706
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX240401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice