Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 0023074 | TX |
N | 1223P0221X | Pediatric Dentist | DN012969 | GA |
NPI | 1073673281 |
---|---|
Provider Name | Dr. Tepphanie Phimeans Thach |
First Address | Bellaire, TX 77401-2997 |
Second Address | Houston, TX 77060-1907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 18/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100201 | AVESIS MEDICAID (01) | GA |
609422190A | (05) | GA |
9181147 | DORAL MEDICAID (01) | GA |