Provider Demographics
NPI:1326475526
Name:PHAM, DAVID KHUONG (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KHUONG
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 1:2220 E SERENE AVE
Mailing Address - Street 2:SUITE #100-3
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-4818
Mailing Address - Country:US
Mailing Address - Phone:702-263-3373
Mailing Address - Fax:702-263-0690
Practice Address - Street 1:2220 E SERENE AVE
Practice Address - Street 2:SUITE #100-3
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-4818
Practice Address - Country:US
Practice Address - Phone:702-263-3373
Practice Address - Fax:702-263-0690
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4351122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist