Provider Demographics
NPI:1467643833
Name:PHAM, TUAN QUOC (DDS)
Entity Type:Individual
Prefix:
First Name:TUAN
Middle Name:QUOC
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 1:1411 LAUREL LEAF LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-3551
Mailing Address - Country:US
Mailing Address - Phone:281-412-4426
Mailing Address - Fax:
Practice Address - Street 1:4300 FAIRMONT PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3306
Practice Address - Country:US
Practice Address - Phone:281-991-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX234181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice