Provider Demographics
NPI:1578669834
Name:PHAM, QUYNH-TRANG NGUYEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:QUYNH-TRANG
Middle Name:NGUYEN
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 1:135 SHRIKE CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2644
Mailing Address - Country:US
Mailing Address - Phone:916-515-4145
Mailing Address - Fax:
Practice Address - Street 1:4261 TRUXEL RD
Practice Address - Street 2:SUITE A-3
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-3724
Practice Address - Country:US
Practice Address - Phone:916-419-8777
Practice Address - Fax:916-419-8787
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA438431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice