Provider Demographics
NPI:1740519206
Name:SEN, PHUONGCHI PHAN (DMD)
Entity type:Individual
Prefix:DR
First Name:PHUONGCHI
Middle Name:PHAN
Last Name:SEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5834 LOUETTA RD STE C
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7884
Mailing Address - Country:US
Mailing Address - Phone:832-843-6481
Mailing Address - Fax:832-843-6475
Practice Address - Street 1:5834 LOUETTA RD STE C
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7884
Practice Address - Country:US
Practice Address - Phone:832-843-6481
Practice Address - Fax:832-843-6475
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-12
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210036405Medicaid
TX210036404Medicaid