Provider Demographics
NPI:1801933387
Name:DUONG, PHONG QUOC (DDS)
Entity type:Individual
Prefix:MR
First Name:PHONG
Middle Name:QUOC
Last Name:DUONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11210 VETERANS MEMORIAL
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-3758
Mailing Address - Country:US
Mailing Address - Phone:281-447-1223
Mailing Address - Fax:281-447-8070
Practice Address - Street 1:11210 VETERANS MEMORIAL DR.
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-3758
Practice Address - Country:US
Practice Address - Phone:281-447-1223
Practice Address - Fax:281-447-8070
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice