NPIMap

Organization Active NPI

Phantastic Family Dental Center

  • General Practice Dentistry
  • Pasadena, TX
National Provider Identifier
1174800486
Registry record updated Nov 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
19016 Issued in TX
Legal business name
PHANTASTIC FAMILY DENTAL CENTER
Practice address
720 Pasadena Blvd
Pasadena, TX 77506-5334
Phone
(713) 473-3163
NPI assigned
Nov 15, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Minh Phan, D.D.S
Title
President
Phone
(713) 473-3163

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 19016 TX Primary

Addresses

Primary practice location

720 Pasadena Blvd
Pasadena, TX 77506-5334

Mailing address

720 Pasadena Blvd
Pasadena, TX 77506-5334
Phone (713) 473-3163

Other names 1

  • Minh Phan D.D.S PA Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321315200000",
    "number": "1174800486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 PASADENA BLVD",
            "city": "PASADENA",
            "state": "TX",
            "postal_code": "775065334",
            "telephone_number": "713-473-3163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 PASADENA BLVD",
            "city": "PASADENA",
            "state": "TX",
            "postal_code": "775065334",
            "telephone_number": "713-473-3163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHANTASTIC FAMILY DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-15",
        "last_updated": "2011-11-15",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "MINH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "713-473-3163",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "19016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minh Phan D.D.S PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pasadena, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.