Provider Demographics
NPI:1285906487
Name:1ST CARE DENTAL, P.A.
Entity type:Organization
Organization Name:1ST CARE DENTAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHUONGHANH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-256-7331
Mailing Address - Street 1:29110 HIGHWAY 290
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-4681
Mailing Address - Country:US
Mailing Address - Phone:281-256-7331
Mailing Address - Fax:
Practice Address - Street 1:29110 HIGHWAY 290
Practice Address - Street 2:SUITE 200
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4681
Practice Address - Country:US
Practice Address - Phone:281-256-7331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX305895001Medicaid