Provider Demographics
NPI:1952578551
Name:THAI DENTAL CLINIC
Entity Type:Organization
Organization Name:THAI DENTAL CLINIC
Other - Org Name:FIREWHEEL DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:UYEN
Authorized Official - Middle Name:PHUONG
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-276-5025
Mailing Address - Street 1:3465 W WALNUT ST
Mailing Address - Street 2:SUITE #209
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-7153
Mailing Address - Country:US
Mailing Address - Phone:972-276-5025
Mailing Address - Fax:972-487-0656
Practice Address - Street 1:3465 W WALNUT ST
Practice Address - Street 2:SUITE #209
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-7153
Practice Address - Country:US
Practice Address - Phone:972-276-5025
Practice Address - Fax:972-487-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX181871223G0001X
TX181591223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty