Provider Demographics
NPI:1871642793
Name:PHAN, THANHHANG THI (D D S)
Entity Type:Individual
Prefix:
First Name:THANHHANG
Middle Name:THI
Last Name:PHAN
Suffix:
Gender:F
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8324 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1603
Mailing Address - Country:US
Mailing Address - Phone:713-772-3499
Mailing Address - Fax:713-772-3959
Practice Address - Street 1:8324 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1603
Practice Address - Country:US
Practice Address - Phone:713-772-3499
Practice Address - Fax:713-772-3959
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice