# LA COSTA DENTAL OF KOSTORYZ PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245658798
- **Authorized official:** DR. TIEN DINH PHAN DMD (DENTIST)
- **Authorized official phone:** (817) 531-3500

## Contact information

- **Practice address:** 4506 KOSTORYZ RD, CORPUS CHRISTI, TX 78415-5023
- **Practice address phone:** (817) 531-3500
- **Practice address fax:** (817) 531-3501
- **Mailing address:** 8150 SPRINGWOOD DR \# 150B, IRVING, TX 75063-5810

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 22334 | TX | Yes |

## Other

- **Enumeration date:** 04/02/2014
- **Last updated:** 10/25/2021