Provider Demographics
NPI:1710675210
Name:HQ DENTAL TEXAS PLLC
Entity Type:Organization
Organization Name:HQ DENTAL TEXAS PLLC
Other - Org Name:HQ TEMPLE DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:HIEP
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:949-232-0236
Mailing Address - Street 1:4554 MIRAVAL LOOP
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-3929
Mailing Address - Country:US
Mailing Address - Phone:949-232-0236
Mailing Address - Fax:
Practice Address - Street 1:3126 THORNTON LN
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1735
Practice Address - Country:US
Practice Address - Phone:254-773-1672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty