Provider Demographics
NPI:1912681735
Name:MTV DENTAL, PLLC
Entity Type:Organization
Organization Name:MTV DENTAL, PLLC
Other - Org Name:A7 DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-240-3210
Mailing Address - Street 1:636 HIGHWAY 6 STE 700
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-5143
Mailing Address - Country:US
Mailing Address - Phone:281-240-3210
Mailing Address - Fax:281-240-3218
Practice Address - Street 1:636 HIGHWAY 6 STE 700
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-5143
Practice Address - Country:US
Practice Address - Phone:281-240-3210
Practice Address - Fax:281-240-3218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty