Provider Demographics
NPI:1174652564
Name:PHAM, HUONG T (DMD)
Entity Type:Individual
Prefix:DR
First Name:HUONG
Middle Name:T
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 1:365 HALTON RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3405
Mailing Address - Country:US
Mailing Address - Phone:864-546-5393
Mailing Address - Fax:864-990-4046
Practice Address - Street 1:365 HALTON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3405
Practice Address - Country:US
Practice Address - Phone:864-546-5393
Practice Address - Fax:864-990-4046
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice