Provider Demographics
NPI:1750502126
Name:LA, THUC M (DDS)
Entity Type:Individual
Prefix:DR
First Name:THUC
Middle Name:M
Last Name:LA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11201 BELLAIRE BLVD BLDG STE A-18
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-2544
Mailing Address - Country:US
Mailing Address - Phone:281-568-8200
Mailing Address - Fax:281-271-8453
Practice Address - Street 1:11201 BELLAIRE BLVD
Practice Address - Street 2:A-18
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-2544
Practice Address - Country:US
Practice Address - Phone:281-568-8200
Practice Address - Fax:281-568-8884
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX190801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090819604Medicaid
TX090819601Medicaid
TX090819605Medicaid