Provider Demographics
NPI:1225166101
Name:THAM, FOENG T
Entity Type:Individual
Prefix:DR
First Name:FOENG
Middle Name:T
Last Name:THAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6375 W CHARLESTON BLVD
Mailing Address - Street 2:A500
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1139
Mailing Address - Country:US
Mailing Address - Phone:702-651-5510
Mailing Address - Fax:702-651-5029
Practice Address - Street 1:6375 W CHARLESTON BLVD
Practice Address - Street 2:A500
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1139
Practice Address - Country:US
Practice Address - Phone:702-651-5510
Practice Address - Fax:702-651-5029
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV26901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice