Provider Demographics
NPI:1477887347
Name:PHAN-DINH, KIM THOA (DDS)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:THOA
Last Name:PHAN-DINH
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 1:7341 W SAND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5310
Mailing Address - Country:US
Mailing Address - Phone:407-781-0386
Mailing Address - Fax:
Practice Address - Street 1:7341 W SAND LAKE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5310
Practice Address - Country:US
Practice Address - Phone:407-781-0386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL237881223G0001X
NE68561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA08681OtherIOWA LICENSE
NE6856OtherSTATE LICENSE