Provider Demographics
NPI:1316188030
Name:PHAM, MARY REGINA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:REGINA
Last Name:PHAM
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 E YORBA LINDA BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3760
Mailing Address - Country:US
Mailing Address - Phone:714-528-8252
Mailing Address - Fax:
Practice Address - Street 1:1041 E YORBA LINDA BLVD STE 206
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3760
Practice Address - Country:US
Practice Address - Phone:714-528-8252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA602221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry