Provider Demographics
NPI:1457445611
Name:PHAM, KHANH ANH (DDS)
Entity Type:Individual
Prefix:
First Name:KHANH
Middle Name:ANH
Last Name:PHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5232 MEADOW CREST DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-3023
Mailing Address - Country:US
Mailing Address - Phone:972-241-1962
Mailing Address - Fax:
Practice Address - Street 1:13260 JOSEY LN
Practice Address - Street 2:SUITE 101
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-4973
Practice Address - Country:US
Practice Address - Phone:972-241-1962
Practice Address - Fax:972-241-2339
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist