Provider Demographics
NPI:1295187177
Name:PHAM, PETE (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETE
Middle Name:
Last Name:PHAM
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 1:1811 PEPPERTREE DR
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2741
Mailing Address - Country:US
Mailing Address - Phone:813-448-6555
Mailing Address - Fax:
Practice Address - Street 1:1811 PEPPERTREE DR
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-2741
Practice Address - Country:US
Practice Address - Phone:813-448-6555
Practice Address - Fax:855-576-4539
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist