Provider Demographics
NPI:1104436831
Name:MENG, TIAN
Entity type:Individual
Prefix:DR
First Name:TIAN
Middle Name:
Last Name:MENG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5303 HAMILTON WOLFE RD APT 1018
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4365
Mailing Address - Country:US
Mailing Address - Phone:210-473-9165
Mailing Address - Fax:
Practice Address - Street 1:8411 FM 359 RD S STE E
Practice Address - Street 2:
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-6409
Practice Address - Country:US
Practice Address - Phone:832-743-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist