Provider Demographics
NPI:1811378466
Name:RADIANT DENTAL - WESTCHASE
Entity Type:Organization
Organization Name:RADIANT DENTAL - WESTCHASE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THUY
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:832-419-0918
Mailing Address - Street 1:3730 S. GESSNER RD
Mailing Address - Street 2:C-100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063
Mailing Address - Country:US
Mailing Address - Phone:832-834-5544
Mailing Address - Fax:832-834-5590
Practice Address - Street 1:3730 S. GESSNER RD.
Practice Address - Street 2:C-100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063
Practice Address - Country:US
Practice Address - Phone:832-834-5544
Practice Address - Fax:832-834-5590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23389261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental