Provider Demographics
NPI:1427206622
Name:PHAM, GABRIELLA THANH-NGOC (DDS)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLA
Middle Name:THANH-NGOC
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 1:1640 E 1ST ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-6394
Mailing Address - Country:US
Mailing Address - Phone:714-245-9888
Mailing Address - Fax:714-245-9808
Practice Address - Street 1:1640 E 1ST ST
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-6394
Practice Address - Country:US
Practice Address - Phone:714-245-9888
Practice Address - Fax:714-245-9808
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA427611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice