Provider Demographics
NPI:1295800704
Name:METRO DENTAL, PA
Entity type:Organization
Organization Name:METRO DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:HAI
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-580-7620
Mailing Address - Street 1:12790 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-2048
Mailing Address - Country:US
Mailing Address - Phone:281-580-7620
Mailing Address - Fax:
Practice Address - Street 1:12790 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-2048
Practice Address - Country:US
Practice Address - Phone:281-580-7620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG60040-4OtherCHIPPA
TXG60040-2OtherCHIPFM
TXG60040-6OtherCHIPMA
TXG60040-3OtherCHIPBF
TXG60040-1OtherCHIPVM
TXG60040-5OtherCHIPLP