Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 16985 | TX |
NPI | 1003931817 |
---|---|
Provider Name | Dr. Tim T Ngo |
First Address | Garland, TX 75042-8203 |
Second Address | Garland, TX 75042-8203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |