Provider Demographics
NPI:1811134620
Name:PHAM & LUCAS ENTERPRISES, INC
Entity type:Organization
Organization Name:PHAM & LUCAS ENTERPRISES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIEP
Authorized Official - Middle Name:T
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-741-7400
Mailing Address - Street 1:PO BOX 38602
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77238-8602
Mailing Address - Country:US
Mailing Address - Phone:281-741-7400
Mailing Address - Fax:281-741-7406
Practice Address - Street 1:8240 ANTOINE DR
Practice Address - Street 2:206
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-2534
Practice Address - Country:US
Practice Address - Phone:281-741-7400
Practice Address - Fax:281-741-7406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX178621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0908501-01Medicaid
TX0098170-01Medicaid