Provider Demographics
NPI:1174509848
Name:PHAM, AMY H (DDS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:H
Last Name:PHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 CORTINA DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95963-1699
Mailing Address - Country:US
Mailing Address - Phone:530-865-5561
Mailing Address - Fax:530-865-9209
Practice Address - Street 1:1211 CORTINA DR
Practice Address - Street 2:
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963-1699
Practice Address - Country:US
Practice Address - Phone:530-865-5561
Practice Address - Fax:530-865-9209
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABP8530267OtherDEA