Active NPI
Nam Manh Phung, DMD
- General Practice Dentistry
- Dickinson, TX
National Provider Identifier
1043972904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 37620
- Practice address
- 1620 FM 646 Rd W Ste D
Dickinson, TX 77539-4580 - Phone
- (714) 463-0478
- NPI assigned
- Oct 8, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 37620 | TX | Primary |
Addresses
Primary practice location
1620 FM 646 Rd W Ste D
Dickinson, TX 77539-4580
Mailing address
2555 E League City Pkwy Ste 160
League City, TX 77573-7103
Phone (714) 463-0478
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37620 | TX | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648944000000",
"number": "1043972904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2555 E LEAGUE CITY PKWY STE 160",
"city": "LEAGUE CITY",
"state": "TX",
"postal_code": "775737103",
"telephone_number": "714-463-0478"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1620 FM 646 RD W STE D",
"city": "DICKINSON",
"state": "TX",
"postal_code": "775394580",
"telephone_number": "714-463-0478"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHUNG",
"first_name": "NAM",
"middle_name": "MANH",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-10-08",
"last_updated": "2022-04-03",
"certification_date": "2022-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "37620",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dickinson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.