Provider Demographics
NPI:1639389471
Name:PHAM, TRANG T (RDH)
Entity Type:Individual
Prefix:MS
First Name:TRANG
Middle Name:T
Last Name:PHAM
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 SEVERN AVE
Mailing Address - Street 2:B206
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1949
Mailing Address - Country:US
Mailing Address - Phone:504-913-6904
Mailing Address - Fax:
Practice Address - Street 1:3809 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-1625
Practice Address - Country:US
Practice Address - Phone:504-833-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA33701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice