Provider Demographics
NPI:1073685269
Name:PHAM, THANH HOAI (DDS)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:HOAI
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 1:277 S RANCHO SANTA FE RD
Mailing Address - Street 2:#J
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2342
Mailing Address - Country:US
Mailing Address - Phone:760-744-8314
Mailing Address - Fax:760-744-9174
Practice Address - Street 1:277 S RANCHO SANTA FE RD
Practice Address - Street 2:#J
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2342
Practice Address - Country:US
Practice Address - Phone:760-744-8314
Practice Address - Fax:760-744-9174
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11353122300000X, 1223G0001X
CADDS1048001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist