Provider Demographics
NPI:1669542866
Name:GRAND CENTURY DENTAL CENTER
Entity type:Organization
Organization Name:GRAND CENTURY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUNG
Authorized Official - Middle Name:MINH
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-999-0480
Mailing Address - Street 1:1111 STORY RD
Mailing Address - Street 2:STE 1037
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122
Mailing Address - Country:US
Mailing Address - Phone:408-999-0480
Mailing Address - Fax:408-288-8212
Practice Address - Street 1:1111 STORY RD
Practice Address - Street 2:STE 1037
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122
Practice Address - Country:US
Practice Address - Phone:408-999-0480
Practice Address - Fax:408-288-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB44548122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty