Provider Demographics
NPI:1689718959
Name:PHAM, TOAI CONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOAI
Middle Name:CONG
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 1:11066 PECAN PARK BLVD
Mailing Address - Street 2:SUITE #411
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-1515
Mailing Address - Country:US
Mailing Address - Phone:512-219-7484
Mailing Address - Fax:512-219-6505
Practice Address - Street 1:11066 PECAN PARK BLVD
Practice Address - Street 2:SUITE #411
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-1515
Practice Address - Country:US
Practice Address - Phone:512-219-7484
Practice Address - Fax:512-219-6505
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice