Provider Demographics
NPI:1518579226
Name:PHAM, JESSICA T (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:T
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 1:3363 MCCUE RD APT 441
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-6762
Mailing Address - Country:US
Mailing Address - Phone:361-463-1160
Mailing Address - Fax:
Practice Address - Street 1:4125 RICHMOND PKWY # 110
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-2508
Practice Address - Country:US
Practice Address - Phone:281-560-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist