1427277151 NPI number — THE HUNG PHAM,D.D.S., P.A.

Table of content: (NPI 1427277151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427277151 NPI number — THE HUNG PHAM,D.D.S., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HUNG PHAM,D.D.S., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BENT TREE DENTAL ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427277151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
145 OYSTER CREEK DR
Provider Second Line Business Mailing Address:
STE 8
Provider Business Mailing Address City Name:
LAKE JACKSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77566-4197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-297-3882
Provider Business Mailing Address Fax Number:
979-297-4497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 OYSTER CREEK DR
Provider Second Line Business Practice Location Address:
STE 8
Provider Business Practice Location Address City Name:
LAKE JACKSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77566-4197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-297-3882
Provider Business Practice Location Address Fax Number:
979-297-4497
Provider Enumeration Date:
04/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PHAM
Authorized Official First Name:
THE
Authorized Official Middle Name:
HUNG
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
979-297-3882

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  19655 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)