Individual
DR. TEPPHANIE PHIMEANS THACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
383 GREENS RD STE A, HOUSTON, TX 77060-1907
(281) 872-3777
Mailing address
6300 WEST LOOP S STE 650, BELLAIRE, TX 77401-2997
(713) 663-7960
(713) 349-8027
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
0023074
TX
1223P0221X
Pediatric Dentistry
DN012969
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100201
AVESIS MEDICAID
GA
05
—
609422190A
—
GA
01
—
9181147
DORAL MEDICAID
GA
Enumeration date
12/11/2006
Last updated
07/18/2011
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