Provider Demographics
NPI:1073547550
Name:PHAM, THANG BA (DDS)
Entity Type:Individual
Prefix:DR
First Name:THANG
Middle Name:BA
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 1:6400-K SEVEN CORNERS PLACE
Mailing Address - Street 2:SUITE K
Mailing Address - City:FALLSCHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044
Mailing Address - Country:US
Mailing Address - Phone:703-237-7820
Mailing Address - Fax:703-237-6699
Practice Address - Street 1:6400-K SEVEN CORNERS PLACE
Practice Address - Street 2:SUITE K
Practice Address - City:FALLSCHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044
Practice Address - Country:US
Practice Address - Phone:703-237-7820
Practice Address - Fax:703-237-6699
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA 69151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice