Provider Demographics
NPI:1346450889
Name:PHAN, TUYET MAI T (DDS)
Entity Type:Individual
Prefix:DR
First Name:TUYET MAI
Middle Name:T
Last Name:PHAN
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 1:28675 MORNING DEW WAY
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-6423
Mailing Address - Country:US
Mailing Address - Phone:714-692-9492
Mailing Address - Fax:
Practice Address - Street 1:41593 WINCHESTER RD STE 211
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4857
Practice Address - Country:US
Practice Address - Phone:951-296-3366
Practice Address - Fax:951-296-3377
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice