Provider Demographics
NPI:1912175654
Name:812 TOOTH CARE CORPORATION
Entity Type:Organization
Organization Name:812 TOOTH CARE CORPORATION
Other - Org Name:FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LINH
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-760-2555
Mailing Address - Street 1:727B W DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-2704
Mailing Address - Country:US
Mailing Address - Phone:936-760-2555
Mailing Address - Fax:936-760-2557
Practice Address - Street 1:727B W DAVIS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2704
Practice Address - Country:US
Practice Address - Phone:936-760-2555
Practice Address - Fax:936-760-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty