Provider Demographics
NPI:1760165336
Name:PHAN, MERCEDES MINH-THANH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:MINH-THANH
Last Name:PHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10042 KATHERINE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-2136
Mailing Address - Country:US
Mailing Address - Phone:832-328-3699
Mailing Address - Fax:
Practice Address - Street 1:102 FAIRMONT PKWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2742
Practice Address - Country:US
Practice Address - Phone:713-944-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX399001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice