Provider Demographics
NPI:1629336417
Name:PHAN, ANHTHU DEANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANHTHU DEANA
Middle Name:
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 1:9290 SIERRA COLLEGE BLVD
Mailing Address - Street 2:SUITE #300
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5991
Mailing Address - Country:US
Mailing Address - Phone:916-788-8450
Mailing Address - Fax:916-788-8452
Practice Address - Street 1:9290 SIERRA COLLEGE BLVD
Practice Address - Street 2:SUITE #300
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5991
Practice Address - Country:US
Practice Address - Phone:916-788-8450
Practice Address - Fax:916-788-8452
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA447621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice