Provider Demographics
NPI:1083866503
Name:CHRISTIAN A. PHAM, DMD, LTD
Entity Type:Organization
Organization Name:CHRISTIAN A. PHAM, DMD, LTD
Other - Org Name:CRESTVIEW DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-206-0372
Mailing Address - Street 1:4835 RAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139
Mailing Address - Country:US
Mailing Address - Phone:714-206-0372
Mailing Address - Fax:
Practice Address - Street 1:60 S. STEPHANIE ST.
Practice Address - Street 2:SUITE #100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012
Practice Address - Country:US
Practice Address - Phone:702-558-5788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5342261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental