Provider Demographics
NPI:1932399474
Name:HEALTHY DENTAL, PA
Entity Type:Organization
Organization Name:HEALTHY DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF HEALTHY DENTAL, PA
Authorized Official - Prefix:
Authorized Official - First Name:THANH-HANG
Authorized Official - Middle Name:THI
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-656-2500
Mailing Address - Street 1:16506 FM 529 RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-1416
Mailing Address - Country:US
Mailing Address - Phone:281-656-2500
Mailing Address - Fax:281-656-2518
Practice Address - Street 1:16506 FM 529 RD
Practice Address - Street 2:SUITE 117
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-1416
Practice Address - Country:US
Practice Address - Phone:281-656-2500
Practice Address - Fax:281-656-2518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty