Provider Demographics
NPI:1649269127
Name:GOLDEN FULTON DENTAL
Entity type:Organization
Organization Name:GOLDEN FULTON DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HIEU
Authorized Official - Middle Name:QUANG
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-488-2775
Mailing Address - Street 1:7700 FULTON ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77022-3642
Mailing Address - Country:US
Mailing Address - Phone:713-697-0604
Mailing Address - Fax:713-697-1303
Practice Address - Street 1:7700 FULTON ST STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-3642
Practice Address - Country:US
Practice Address - Phone:713-697-0604
Practice Address - Fax:713-697-1303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19895208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB1989503OtherDELTA DENTAL CA, CHIPS