Provider Demographics
NPI:1982914883
Name:AVENUE DENTAL PLLC
Entity Type:Organization
Organization Name:AVENUE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NGUYEN
Authorized Official - Middle Name:BAO
Authorized Official - Last Name:HATHUC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-670-6116
Mailing Address - Street 1:28010 HOLLYFARE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5144
Mailing Address - Country:US
Mailing Address - Phone:713-670-6116
Mailing Address - Fax:
Practice Address - Street 1:2602 ELDRIDGE PKWY STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-6874
Practice Address - Country:US
Practice Address - Phone:713-670-6116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX249251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty