Provider Demographics
NPI:1538160304
Name:ADVANCED DERM-PLASTIC, P.A.
Entity type:Organization
Organization Name:ADVANCED DERM-PLASTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANH
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-351-9823
Mailing Address - Street 1:455 SCHOOL ST
Mailing Address - Street 2:SUITE 49
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4593
Mailing Address - Country:US
Mailing Address - Phone:281-351-9823
Mailing Address - Fax:281-351-7711
Practice Address - Street 1:455 SCHOOL ST
Practice Address - Street 2:SUITE 49
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4593
Practice Address - Country:US
Practice Address - Phone:281-351-9823
Practice Address - Fax:281-351-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty