Provider Demographics
NPI:1003415951
Name:PHAM, TAMMY (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16584 MOUNT SHELLY CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2440
Mailing Address - Country:US
Mailing Address - Phone:714-706-2604
Mailing Address - Fax:
Practice Address - Street 1:4986 WATT AVE STE D
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-5182
Practice Address - Country:US
Practice Address - Phone:916-642-1867
Practice Address - Fax:844-491-6066
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105622122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist