Provider Demographics
NPI:1427369750
Name:OCEANSIDE DENTAL ART LP
Entity type:Organization
Organization Name:OCEANSIDE DENTAL ART LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIEP
Authorized Official - Middle Name:THI
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-208-2016
Mailing Address - Street 1:PO BOX 2086
Mailing Address - Street 2:
Mailing Address - City:ALIEF
Mailing Address - State:TX
Mailing Address - Zip Code:77411-2086
Mailing Address - Country:US
Mailing Address - Phone:281-208-2016
Mailing Address - Fax:
Practice Address - Street 1:1301 E LOS EBANOS BLVD # D
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8634
Practice Address - Country:US
Practice Address - Phone:281-208-2016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17862122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty