Provider Demographics
NPI:1508059882
Name:ANN PHAM D.D.S., P.C.
Entity Type:Organization
Organization Name:ANN PHAM D.D.S., P.C.
Other - Org Name:MIRACLE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:T A
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-456-0056
Mailing Address - Street 1:8001 N DURANGO DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89143
Mailing Address - Country:US
Mailing Address - Phone:702-456-0056
Mailing Address - Fax:702-456-0052
Practice Address - Street 1:4210 W CRAIG RD
Practice Address - Street 2:SUITE #104
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-2734
Practice Address - Country:US
Practice Address - Phone:702-436-5222
Practice Address - Fax:702-873-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4078122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty