Provider Demographics
NPI:1003937814
Name:LYNH THY PHAM D D S PA
Entity Type:Organization
Organization Name:LYNH THY PHAM D D S PA
Other - Org Name:SMILEY DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNH THY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:214-368-4331
Mailing Address - Street 1:324 MEDALLION CENTER
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-1580
Mailing Address - Country:US
Mailing Address - Phone:214-368-4331
Mailing Address - Fax:214-368-4661
Practice Address - Street 1:324 MEDALLION CENTER
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-1580
Practice Address - Country:US
Practice Address - Phone:214-368-4331
Practice Address - Fax:214-368-4661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159880701Medicaid