# ABC123 DENTAL IN HALTOM PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ABC123 Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740569144
- **Authorized official:** DR. TRI H PHAM DDS (OWNER/DENTIST)
- **Authorized official phone:** (817) 656-1215

## Contact information

- **Practice address:** 5416 BASSWOOD BLVD, FORT WORTH, TX 76137-4400
- **Practice address phone:** (817) 656-1215
- **Practice address fax:** (877) 687-6861
- **Mailing address:** 5416 BASSWOOD BLVD, FORT WORTH, TX 76137-4400
- **Mailing address phone:** (817) 656-1215
- **Mailing address fax:** (877) 687-6861

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 24570 | TX | Yes |

## Other

- **Enumeration date:** 08/16/2011
- **Last updated:** 08/16/2011