Provider Demographics
NPI:1447213913
Name:PHAM, DENISE P (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:P
Last Name:PHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:427 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-3743
Mailing Address - Country:US
Mailing Address - Phone:214-755-2127
Mailing Address - Fax:469-948-0341
Practice Address - Street 1:2741 E BELT LINE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-5445
Practice Address - Country:US
Practice Address - Phone:972-820-7294
Practice Address - Fax:972-820-8217
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice