Provider Demographics
NPI:1699011577
Name:TRUC PHAN, DDS, PC
Entity Type:Organization
Organization Name:TRUC PHAN, DDS, PC
Other - Org Name:EVERCARE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRUC
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-358-1868
Mailing Address - Street 1:2141 E ARAPAHO RD
Mailing Address - Street 2:140
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3185
Mailing Address - Country:US
Mailing Address - Phone:469-358-1868
Mailing Address - Fax:
Practice Address - Street 1:2141 E ARAPAHO RD
Practice Address - Street 2:140
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-3185
Practice Address - Country:US
Practice Address - Phone:469-358-1868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX240401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty