Provider Demographics
NPI:1487843140
Name:DING, MICHAEL PHAM (DDS MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PHAM
Last Name:DING
Suffix:
Gender:M
Credentials:DDS MD
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Mailing Address - Street 1:P.O. BOX 49500
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78765-9500
Mailing Address - Country:US
Mailing Address - Phone:512-454-1220
Mailing Address - Fax:512-467-0363
Practice Address - Street 1:1785 E. WHITESTONE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-5635
Practice Address - Country:US
Practice Address - Phone:512-258-3764
Practice Address - Fax:512-258-6348
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2014-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX218191223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery