Provider Demographics
NPI:1851410179
Name:BLALOCK DENTAL CLINIC ,P.C.
Entity Type:Organization
Organization Name:BLALOCK DENTAL CLINIC ,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:TINHVAN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-722-0888
Mailing Address - Street 1:1304 BLALOCK RD STE E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6475
Mailing Address - Country:US
Mailing Address - Phone:713-722-0888
Mailing Address - Fax:713-722-0892
Practice Address - Street 1:1304 BLALOCK RD STE E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6475
Practice Address - Country:US
Practice Address - Phone:713-722-0888
Practice Address - Fax:713-722-0892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDENT51045Medicaid