Provider Demographics
NPI:1194901744
Name:FAIR OAKS DENTAL, PA
Entity type:Organization
Organization Name:FAIR OAKS DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUYEN
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-698-9100
Mailing Address - Street 1:9091 FAIR OAKS PKWY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:FAIR OAKS RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78015
Mailing Address - Country:US
Mailing Address - Phone:210-698-9100
Mailing Address - Fax:
Practice Address - Street 1:9091 FAIR OAKS PKWY
Practice Address - Street 2:SUITE 304
Practice Address - City:FAIR OAKS RANCH
Practice Address - State:TX
Practice Address - Zip Code:78015
Practice Address - Country:US
Practice Address - Phone:210-698-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty