Provider Demographics
NPI:1184179616
Name:PHAM, THERESE NGOC (DMD)
Entity Type:Individual
Prefix:DR
First Name:THERESE
Middle Name:NGOC
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 1:201 SE WASHINGTON ST STE A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-2860
Mailing Address - Country:US
Mailing Address - Phone:503-507-0996
Mailing Address - Fax:
Practice Address - Street 1:201 SE WASHINGTON ST STE A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-2860
Practice Address - Country:US
Practice Address - Phone:503-507-0996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD110151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry