Provider Demographics
NPI:1861637951
Name:PHONG NGUYEN D.D.S. PC
Entity Type:Organization
Organization Name:PHONG NGUYEN D.D.S. PC
Other - Org Name:STEEPLECHASE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHONG
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-955-2800
Mailing Address - Street 1:9595 JONES RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065
Mailing Address - Country:US
Mailing Address - Phone:281-955-2800
Mailing Address - Fax:281-955-5353
Practice Address - Street 1:9595 JONES RD.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065
Practice Address - Country:US
Practice Address - Phone:281-955-2800
Practice Address - Fax:281-955-5353
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHONG NGUYEN D.D.S
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-03
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223981223G0001X
TX245531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty