Provider Demographics
NPI:1801114491
Name:BROWNTRAILDENTAL
Entity type:Organization
Organization Name:BROWNTRAILDENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-510-2960
Mailing Address - Street 1:1404 BROWN TRL
Mailing Address - Street 2:#C
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6497
Mailing Address - Country:US
Mailing Address - Phone:817-510-2960
Mailing Address - Fax:817-510-2967
Practice Address - Street 1:1404 BROWN TRL
Practice Address - Street 2:#C
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6497
Practice Address - Country:US
Practice Address - Phone:817-510-2960
Practice Address - Fax:817-510-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23212122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty