Provider Demographics
NPI:1376689075
Name:HUYNH, PHAN K (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHAN
Middle Name:K
Last Name:HUYNH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 S WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-5812
Mailing Address - Country:US
Mailing Address - Phone:609-345-1155
Mailing Address - Fax:609-345-5323
Practice Address - Street 1:1 S NEW YORK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-8012
Practice Address - Country:US
Practice Address - Phone:609-345-1155
Practice Address - Fax:609-345-5323
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI019403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist