Active NPI
Andrew Phan, DDS
- Dentist
- Houston, TX
National Provider Identifier
1225521966
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 33988
- Practice address
- 12168 Bellaire Blvd Ste 100
Houston, TX 77072-2642 - Phone
- (281) 400-1111
- NPI assigned
- Jun 7, 2018
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 33988 | TX | Primary |
Addresses
Primary practice location
12168 Bellaire Blvd Ste 100
Houston, TX 77072-2642
Mailing address
2900 N Braeswood Blvd Apt 3308
Houston, TX 77025-2372
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 |
|---|---|---|---|
| 33988 | TX | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fresh Ortho Care, PLLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Orthodontics and Dentofacial Orthopedics Dentistry
- Houston, TX
- NPI 1174972996
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528329600000",
"number": "1225521966",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 N BRAESWOOD BLVD APT 3308",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770252372"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12168 BELLAIRE BLVD STE 100",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770722642",
"telephone_number": "281-400-1111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "ANDREW",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-06-07",
"last_updated": "2018-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "33988",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.