Provider Demographics
NPI:1326151606
Name:PHAN, NANCY D (DDS MS)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:D
Last Name:PHAN
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:88 TULLY RD
Mailing Address - Street 2:STE 113
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1923
Mailing Address - Country:US
Mailing Address - Phone:408-971-2885
Mailing Address - Fax:408-971-2831
Practice Address - Street 1:88 TULLY RD
Practice Address - Street 2:STE 113
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-1923
Practice Address - Country:US
Practice Address - Phone:408-971-2885
Practice Address - Fax:408-971-2831
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA488461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics