Provider Demographics
NPI:1295841997
Name:PHAM, DAVID H (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:PHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1518
Mailing Address - Country:US
Mailing Address - Phone:714-330-1194
Mailing Address - Fax:
Practice Address - Street 1:1000 E IMPERIAL HWY STE A1
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5602
Practice Address - Country:US
Practice Address - Phone:714-330-1194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA486621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice