Provider Demographics
NPI:1891311510
Name:WALLISVILLE BRACES, PLLC
Entity Type:Organization
Organization Name:WALLISVILLE BRACES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KHOI
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-858-8916
Mailing Address - Street 1:14570 WALLISVILLE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-4300
Mailing Address - Country:US
Mailing Address - Phone:832-858-8916
Mailing Address - Fax:
Practice Address - Street 1:14570 WALLISVILLE RD STE 1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-4300
Practice Address - Country:US
Practice Address - Phone:832-858-8916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental