Provider Demographics
NPI:1609936764
Name:PHAM, CINDY HUONG THU (DMD)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:HUONG THU
Last Name:PHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12568 W FLOWER ST
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-6376
Mailing Address - Country:US
Mailing Address - Phone:480-678-4699
Mailing Address - Fax:
Practice Address - Street 1:7448 W GLENDALE AVE STE 126
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85303-2575
Practice Address - Country:US
Practice Address - Phone:623-930-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD66741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice