Provider Demographics
NPI:1124183322
Name:PHAM, LINH THI-THUY (DMD)
Entity Type:Individual
Prefix:DR
First Name:LINH
Middle Name:THI-THUY
Last Name:PHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8833 AUBURN WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1201
Mailing Address - Country:US
Mailing Address - Phone:813-884-9764
Mailing Address - Fax:
Practice Address - Street 1:15148 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1817
Practice Address - Country:US
Practice Address - Phone:813-960-0106
Practice Address - Fax:813-964-5474
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist