Provider Demographics
NPI:1033510771
Name:PHAM, JEFFEREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFEREY
Middle Name:
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 1:7812 WARNER AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-4700
Mailing Address - Country:US
Mailing Address - Phone:714-375-3222
Mailing Address - Fax:714-375-3223
Practice Address - Street 1:7812 WARNER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-4700
Practice Address - Country:US
Practice Address - Phone:714-375-3222
Practice Address - Fax:714-375-3223
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA638301223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral Practice