Basic Information
| Provider Information | |||||||||
| NPI: | 1023331774 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HUY QUACH DDS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2120 EL PASEO ST | ||||||||
| Address2: | APT 1504 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770543241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8325497402 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15634 WALLISVILLE RD | ||||||||
| Address2: | 900 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770494635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8325497402 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2010 | ||||||||
| LastUpdateDate: | 03/10/2010 | ||||||||
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| AuthorizedOfficialLastName: | QUACH | ||||||||
| AuthorizedOfficialFirstName: | HUY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8325497402 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 24085 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 24085 | 01 | TX | DENTAL LICENSE NUMBER | OTHER | FQ0997633 | 01 | TX | DEA NUMBER | OTHER |