Provider Demographics
NPI:1265603856
Name:ACCESS DENTAL OF RUNDBERG
Entity type:Organization
Organization Name:ACCESS DENTAL OF RUNDBERG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIEN
Authorized Official - Middle Name:DINH
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-837-0200
Mailing Address - Street 1:8150 SPRINGWOOD DR # 150B
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:825 E RUNDBERG LN
Practice Address - Street 2:SUITE A-1
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-4808
Practice Address - Country:US
Practice Address - Phone:512-837-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty