Provider Demographics
NPI:1467094185
Name:DAVID PHAM DENTAL CORPORATION
Entity Type:Organization
Organization Name:DAVID PHAM DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST- OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-330-1194
Mailing Address - Street 1:1000 E IMPERIAL HWY STE A1
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5602
Mailing Address - Country:US
Mailing Address - Phone:714-257-6453
Mailing Address - Fax:
Practice Address - Street 1:1000 E IMPERIAL HWY STE A1
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5602
Practice Address - Country:US
Practice Address - Phone:714-257-6453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty