Provider Demographics
NPI:1891854154
Name:ADC SERVICES : DENTAL P.C
Entity Type:Organization
Organization Name:ADC SERVICES : DENTAL P.C
Other - Org Name:ALLIED FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUONG
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-773-9800
Mailing Address - Street 1:11001 FONDREN ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-5676
Mailing Address - Country:US
Mailing Address - Phone:713-773-9800
Mailing Address - Fax:713-773-9800
Practice Address - Street 1:11001 FONDREN ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-5676
Practice Address - Country:US
Practice Address - Phone:713-773-9800
Practice Address - Fax:713-773-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16986122300000X
1223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1396365920Medicaid
TX1861554198Medicaid
TX1831258508Medicaid
TX0098006-01Medicaid
TX1891854154Medicaid