Provider Demographics
NPI:1922447010
Name:PHAN, CUONG QUOC (DDS)
Entity Type:Individual
Prefix:DR
First Name:CUONG
Middle Name:QUOC
Last Name:PHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9411 KARI SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-7647
Mailing Address - Country:US
Mailing Address - Phone:832-798-0141
Mailing Address - Fax:
Practice Address - Street 1:12125 HIGHWAY 6
Practice Address - Street 2:SUITE D
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-8843
Practice Address - Country:US
Practice Address - Phone:281-431-8909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist