Provider Demographics
NPI:1710039011
Name:PHAM, KIMBERLY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:L
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 1:3420 NE LOOP 286
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-5003
Mailing Address - Country:US
Mailing Address - Phone:903-784-4591
Mailing Address - Fax:903-784-4682
Practice Address - Street 1:3420 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-5003
Practice Address - Country:US
Practice Address - Phone:903-784-4591
Practice Address - Fax:903-784-4682
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice