Provider Demographics
NPI:1316293848
Name:NGUYEN PHAM, HIEU TIN (DDS)
Entity type:Individual
Prefix:DR
First Name:HIEU
Middle Name:TIN
Last Name:NGUYEN PHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 AIRLINE DR STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77022-3004
Mailing Address - Country:US
Mailing Address - Phone:408-616-9175
Mailing Address - Fax:
Practice Address - Street 1:920 E LITTLE YORK RD, #300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076
Practice Address - Country:US
Practice Address - Phone:408-616-9175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA616701223G0001X
TX282751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice