Provider Demographics
NPI:1861659542
Name:BAYLOR DENTAL & MEDICAL
Entity Type:Organization
Organization Name:BAYLOR DENTAL & MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HOA
Authorized Official - Middle Name:T
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, P A
Authorized Official - Phone:713-521-0525
Mailing Address - Street 1:PO BOX 771526
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77215-1526
Mailing Address - Country:US
Mailing Address - Phone:713-521-0525
Mailing Address - Fax:713-481-5455
Practice Address - Street 1:820 HOLMAN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9520
Practice Address - Country:US
Practice Address - Phone:713-521-0525
Practice Address - Fax:713-481-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15708122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009201701Medicaid
TX165940101Medicaid
TX120802705Medicaid
TX110948003Medicaid
TX036285702Medicaid