Provider Demographics
NPI:1720206451
Name:PHAM, TUAN (DMD)
Entity Type:Individual
Prefix:
First Name:TUAN
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 OLD WASHINGTON RD
Mailing Address - Street 2:STE 204
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3248
Mailing Address - Country:US
Mailing Address - Phone:301-374-9033
Mailing Address - Fax:301-374-9206
Practice Address - Street 1:3450 OLD WASHINGTON RD
Practice Address - Street 2:STE 204
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3248
Practice Address - Country:US
Practice Address - Phone:301-374-9033
Practice Address - Fax:301-374-9206
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist