Provider Demographics
NPI:1639285190
Name:PHAN, TINH T (DDS)
Entity Type:Individual
Prefix:DR
First Name:TINH
Middle Name:T
Last Name:PHAN
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 1:321 SAN FELIPE RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3025
Mailing Address - Country:US
Mailing Address - Phone:408-387-4452
Mailing Address - Fax:
Practice Address - Street 1:321 SAN FELIPE RD
Practice Address - Street 2:SUITE 8
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3025
Practice Address - Country:US
Practice Address - Phone:831-637-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51372122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist