Provider Demographics
NPI:1467442228
Name:PHAM, NICOLE TRANG (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:TRANG
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 1:4 N ABEL ST
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-4833
Mailing Address - Country:US
Mailing Address - Phone:408-942-8808
Mailing Address - Fax:
Practice Address - Street 1:4 N ABEL ST
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-4833
Practice Address - Country:US
Practice Address - Phone:408-942-8808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41518122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist