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5655 Beechnut St Suite #17 Houston TX 77096-1021 | |
| (832) 465-2381 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5655 Beechnut St, Houston, Texas |
| Authorized Official Name and Position | Aegean Lan Phamnguyen (PRESIDENT/CEO) |
| Authorized Official Contact | 8324652381 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5655 Beechnut St Suite #17 Houston TX 77096-1021 Ph: (832) 465-2381 | 5655 Beechnut St Suite #17 Houston TX 77096-1021 Ph: (832) 465-2381 |
| NPI Number | 1912325630 |
|---|---|
| Provider Enumeration Date | 03/31/2014 |
| Last Update Date | 03/31/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912325630 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 27117 (Texas) | Primary |
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