Provider Demographics
NPI:1447224837
Name:PHAM, HEATHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
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:BUILDING 577 STERNBERG AVENUE
Mailing Address - Street 2:HQ USADENTAC CREDENTIALS OFFICE
Mailing Address - City:FORT EUSTIS
Mailing Address - State:VA
Mailing Address - Zip Code:23604-5311
Mailing Address - Country:US
Mailing Address - Phone:757-314-7944
Mailing Address - Fax:757-314-7942
Practice Address - Street 1:BUILDING 577 STERNBERG AVENUE
Practice Address - Street 2:HQ USADENTAC CREDENTIALS OFFICE
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-5311
Practice Address - Country:US
Practice Address - Phone:757-314-7944
Practice Address - Fax:757-314-7942
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411012122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist