Provider Demographics
NPI:1033341110
Name:PHAM, BINH PHUC (DDS)
Entity Type:Individual
Prefix:DR
First Name:BINH
Middle Name:PHUC
Last Name:PHAM
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 1:7880 WREN AVE
Mailing Address - Street 2:SUITE C131
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-4943
Mailing Address - Country:US
Mailing Address - Phone:408-842-3151
Mailing Address - Fax:408-842-0102
Practice Address - Street 1:7880 WREN AVE
Practice Address - Street 2:SUITE C131
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4943
Practice Address - Country:US
Practice Address - Phone:408-842-3151
Practice Address - Fax:408-842-0102
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43844122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist