1891717773 NPI number — ANH VAN DUONG,D.D.S.,P.C.

Table of content: (NPI 1891717773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891717773 NPI number — ANH VAN DUONG,D.D.S.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANH VAN DUONG,D.D.S.,P.C.
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:
Provider Other Organization Name Type Code:
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:
1891717773
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:
7746 PARK PLACE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77087-4528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-649-4800
Provider Business Mailing Address Fax Number:
713-654-1700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7746 PARK PLACE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77087-4528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-649-4800
Provider Business Practice Location Address Fax Number:
713-654-1700
Provider Enumeration Date:
07/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUONG
Authorized Official First Name:
ANH
Authorized Official Middle Name:
VAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-649-4800

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  15143 , 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)

  • Identifier: D15143 . This is a "BLUECROSS & BLUESHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: B-15143-1 . This is a "TEXAS CHIP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".