Provider Demographics
NPI:1194850073
Name:PHAM, DUNG Q (DN)
Entity Type:Individual
Prefix:MR
First Name:DUNG
Middle Name:Q
Last Name:PHAM
Suffix:
Gender:M
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E CASINO RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-1846
Mailing Address - Country:US
Mailing Address - Phone:425-355-4409
Mailing Address - Fax:
Practice Address - Street 1:315 E CASINO RD
Practice Address - Street 2:SUITE B
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-1846
Practice Address - Country:US
Practice Address - Phone:425-355-4409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000360122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist