Provider Demographics
NPI:1033315817
Name:PHAM, THANHHA T (DDS)
Entity Type:Individual
Prefix:
First Name:THANHHA
Middle Name:T
Last Name:PHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:OR
Mailing Address - Zip Code:97048-2634
Mailing Address - Country:US
Mailing Address - Phone:360-224-6445
Mailing Address - Fax:
Practice Address - Street 1:101 W 5TH ST
Practice Address - Street 2:
Practice Address - City:RAINIER
Practice Address - State:OR
Practice Address - Zip Code:97048-2634
Practice Address - Country:US
Practice Address - Phone:360-224-6445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD 8024122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist