Provider Demographics
NPI:1760234165
Name:AFFORDABLE DENTIST NEAR ME PLLC
Entity Type:Organization
Organization Name:AFFORDABLE DENTIST NEAR ME PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHUONG
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-437-6661
Mailing Address - Street 1:3307 MILLER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-1971
Mailing Address - Country:US
Mailing Address - Phone:817-383-1450
Mailing Address - Fax:
Practice Address - Street 1:3307 MILLER AVE STE A
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-1971
Practice Address - Country:US
Practice Address - Phone:817-383-1450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental