Provider Demographics
NPI:1225481567
Name:PHAN, ANTHONY MINHDUC HUY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY MINHDUC
Middle Name:HUY
Last Name:PHAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5041 CHICO DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4277
Mailing Address - Country:US
Mailing Address - Phone:916-622-5681
Mailing Address - Fax:
Practice Address - Street 1:5060 SUNRISE BLVD STE A1
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-4944
Practice Address - Country:US
Practice Address - Phone:916-622-5681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1028341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice