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1316490956
JONATHAN PHAN
AUSTIN, TX
NPI
1316490956
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
122300000X Dentist
(Licence: TX 32869)
Additional Taxonomies
122300000X Dentist
(Licence: OH 30-24859)
Enumeration Date
2016-08-01
Last Update Date
2021-01-20
Business Address
Dr. JONATHAN PHAN D.M.D.
15004 AVERY RANCH BLVD BLDG SUITE100
AUSTIN, TX 78717-4600
Phone number: 512-246-7645
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Mailing Address
Dr. JONATHAN PHAN D.M.D.
15004 AVERY RANCH BLVD STE 100
AUSTIN, TX 78717-4600
Phone number: 512-246-7645
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