Provider Demographics
NPI:1356567630
Name:COSMETIC DENTIST OF KATY, P.A
Entity type:Organization
Organization Name:COSMETIC DENTIST OF KATY, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DINH
Authorized Official - Middle Name:X
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-579-6066
Mailing Address - Street 1:929 S MASON RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-3874
Mailing Address - Country:US
Mailing Address - Phone:281-579-6066
Mailing Address - Fax:
Practice Address - Street 1:929 S MASON RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3874
Practice Address - Country:US
Practice Address - Phone:281-579-6066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty