Provider Demographics
NPI:1437591187
Name:PHAM, NHAN (DMD)
Entity Type:Individual
Prefix:
First Name:NHAN
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8703 BROADWAY ST STE 125
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8098
Mailing Address - Country:US
Mailing Address - Phone:281-485-6088
Mailing Address - Fax:
Practice Address - Street 1:8703 BROADWAY ST STE 125
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8098
Practice Address - Country:US
Practice Address - Phone:281-485-6088
Practice Address - Fax:281-485-1773
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29239122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist