Provider Demographics
NPI:1780113233
Name:NGO, TAM HUU (BD, DMD)
Entity type:Individual
Prefix:DR
First Name:TAM
Middle Name:HUU
Last Name:NGO
Suffix:
Gender:M
Credentials:BD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 SHIRLEY DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-3049
Mailing Address - Country:US
Mailing Address - Phone:916-288-5467
Mailing Address - Fax:
Practice Address - Street 1:505 N ESPLANADE ST
Practice Address - Street 2:
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-3603
Practice Address - Country:US
Practice Address - Phone:361-524-4289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33855122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist