Provider Demographics
NPI:1104840909
Name:PHAM, THIEN CHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:THIEN
Middle Name:CHI
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 1:2490 W RAY RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3559
Mailing Address - Country:US
Mailing Address - Phone:480-234-8200
Mailing Address - Fax:480-302-7958
Practice Address - Street 1:1864 E FLORENCE BLVD
Practice Address - Street 2:SUITE #5
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222
Practice Address - Country:US
Practice Address - Phone:520-876-5200
Practice Address - Fax:480-302-7958
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0125731223G0001X
MA214491223G0001X
VA04014110921223G0001X
IN12010795A1223G0001X
AZ68541223G0001X
CO80231223G0001X
SC41761223G0001X
NMDD20951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice