Provider Demographics
NPI:1285873232
Name:LAMAR DENTAL CENTER
Entity type:Organization
Organization Name:LAMAR DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHUONG
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:D,D,S
Authorized Official - Phone:512-626-7735
Mailing Address - Street 1:9616 N LAMAR BLVD
Mailing Address - Street 2:STE 162
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-4152
Mailing Address - Country:US
Mailing Address - Phone:512-836-6385
Mailing Address - Fax:
Practice Address - Street 1:9616 N LAMAR BLVD
Practice Address - Street 2:STE 162
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-4152
Practice Address - Country:US
Practice Address - Phone:512-836-6385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty