Provider Demographics
NPI:1225481138
Name:PHAM, NGOC (DMD)
Entity Type:Individual
Prefix:DR
First Name:NGOC
Middle Name:
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 1:5116 PERTH GLEN DR
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-5942
Mailing Address - Country:US
Mailing Address - Phone:817-609-9714
Mailing Address - Fax:
Practice Address - Street 1:7861 GREENBACK LN
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610
Practice Address - Country:US
Practice Address - Phone:817-609-9714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31972122300000X
CA102833122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist