Provider Demographics
NPI:1619170818
Name:PHAM, TUAN DUC (DDS)
Entity Type:Individual
Prefix:
First Name:TUAN
Middle Name:DUC
Last Name:PHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7669 W EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9018
Mailing Address - Country:US
Mailing Address - Phone:208-994-7426
Mailing Address - Fax:208-488-4477
Practice Address - Street 1:7669 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9018
Practice Address - Country:US
Practice Address - Phone:949-831-0051
Practice Address - Fax:208-488-4477
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA486631223G0001X
ID44651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice