1952745630 NPI number — EMERALD FAMILY DENTISTRY PLLC

Table of content: (NPI 1952745630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952745630 NPI number — EMERALD FAMILY DENTISTRY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERALD FAMILY DENTISTRY PLLC
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:
EMERALD DENTISTRY
Provider Other Organization Name Type Code:
5
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:
1952745630
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5705 FONDREN RD STE 104
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:
77036-1843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-853-4963
Provider Business Mailing Address Fax Number:
713-781-7829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5705 FONDREN RD STE 104
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:
77036-1843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-853-4963
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
QUYNH
Authorized Official Middle Name:
LAN
Authorized Official Title or Position:
DENTIST/OWNER
Authorized Official Telephone Number:
281-853-4963

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  26347 , 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)