Provider Demographics
NPI:1689654873
Name:PHAM, NATALIE NGOC (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:NGOC
Last Name:PHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 SAINT JAMES CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5600
Mailing Address - Country:US
Mailing Address - Phone:443-799-4662
Mailing Address - Fax:
Practice Address - Street 1:15458 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6210
Practice Address - Country:US
Practice Address - Phone:714-898-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82561223G0001X
MD140221223G0001X
PADS0362621223G0001X
CA642931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice