Provider Demographics
NPI:1326274689
Name:PHAM, ANNIE N (DDS)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:N
Last Name:PHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 THOMAS RD
Mailing Address - Street 2:STE. 203
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-2063
Mailing Address - Country:US
Mailing Address - Phone:408-235-7600
Mailing Address - Fax:408-235-7650
Practice Address - Street 1:3700 THOMAS RD
Practice Address - Street 2:STE. 203
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-2063
Practice Address - Country:US
Practice Address - Phone:408-235-7600
Practice Address - Fax:408-235-7650
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA477751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice