Provider Demographics
NPI:1699025510
Name:PHAM, ANH PHUONG (DDS)
Entity Type:Individual
Prefix:
First Name:ANH
Middle Name:PHUONG
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 1:4318 W FUQUA
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045
Mailing Address - Country:US
Mailing Address - Phone:713-433-7500
Mailing Address - Fax:
Practice Address - Street 1:4318 W FUQUA
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045
Practice Address - Country:US
Practice Address - Phone:713-433-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX284051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice