Provider Demographics
NPI:1689949000
Name:HEALTHY SMILE DENTAL, PA
Entity Type:Organization
Organization Name:HEALTHY SMILE DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF HEALTHY SMILE DENTAL
Authorized Official - Prefix:DR
Authorized Official - First Name:THANHHANG
Authorized Official - Middle Name:THI
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-330-0324
Mailing Address - Street 1:20300 FRANZ RD STE 1
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-5600
Mailing Address - Country:US
Mailing Address - Phone:832-321-4210
Mailing Address - Fax:
Practice Address - Street 1:20300 FRANZ RD
Practice Address - Street 2:SUITE #1
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-5600
Practice Address - Country:US
Practice Address - Phone:832-321-4210
Practice Address - Fax:832-321-4392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty