Provider Demographics
NPI:1548532997
Name:ANEW DENTAL P.C.
Entity type:Organization
Organization Name:ANEW DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, ANEW DENTAL PC
Authorized Official - Prefix:
Authorized Official - First Name:TRINH
Authorized Official - Middle Name:THU
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:940-565-5049
Mailing Address - Street 1:1601 BRINKER RD
Mailing Address - Street 2:UNIT 111
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208
Mailing Address - Country:US
Mailing Address - Phone:940-565-5049
Mailing Address - Fax:940-566-6587
Practice Address - Street 1:1601 BRINKER RD
Practice Address - Street 2:UNIT 111
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208
Practice Address - Country:US
Practice Address - Phone:940-565-5049
Practice Address - Fax:940-566-6587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189844721Medicaid