Provider Demographics
NPI:1295802734
Name:VAN THO, PETER NGUYEN (DDS)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:NGUYEN
Last Name:VAN THO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12002 VETERANS MEMORIAL DRIVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067
Mailing Address - Country:US
Mailing Address - Phone:281-580-7446
Mailing Address - Fax:281-580-7520
Practice Address - Street 1:12002 VETERANS MEMORIAL DRIVE
Practice Address - Street 2:SUITE B3
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067
Practice Address - Country:US
Practice Address - Phone:281-580-7446
Practice Address - Fax:281-580-7520
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090749501Medicaid