Provider Demographics
NPI:1972884237
Name:PHANTASTIC FAMILY DENTAL CARE PA
Entity Type:Organization
Organization Name:PHANTASTIC FAMILY DENTAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MINH
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-330-4138
Mailing Address - Street 1:16 UVALDE RD
Mailing Address - Street 2:F
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-1438
Mailing Address - Country:US
Mailing Address - Phone:713-330-4138
Mailing Address - Fax:713-330-4148
Practice Address - Street 1:16 UVALDE RD
Practice Address - Street 2:F
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-1438
Practice Address - Country:US
Practice Address - Phone:713-330-4138
Practice Address - Fax:713-330-4148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty