Provider Demographics
NPI:1568507721
Name:PHAN, LAUREN THUY-VY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:THUY-VY
Last Name:PHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5720 STONERIDGE MALL RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2828
Mailing Address - Country:US
Mailing Address - Phone:925-847-9800
Mailing Address - Fax:925-847-9801
Practice Address - Street 1:5720 STONERIDGE MALL RD
Practice Address - Street 2:SUITE 320
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2828
Practice Address - Country:US
Practice Address - Phone:925-847-9800
Practice Address - Fax:925-847-9801
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509721223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics