Provider Demographics
NPI:1760699094
Name:HENRY PHAN DDS, PC
Entity Type:Organization
Organization Name:HENRY PHAN DDS, PC
Other - Org Name:FINE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:MINH
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-545-6320
Mailing Address - Street 1:2144 N ARIZONA AVE
Mailing Address - Street 2:SUITE B-14
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-3453
Mailing Address - Country:US
Mailing Address - Phone:480-726-6545
Mailing Address - Fax:480-726-0660
Practice Address - Street 1:2144 N ARIZONA AVE
Practice Address - Street 2:SUITE B-14
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-3453
Practice Address - Country:US
Practice Address - Phone:480-726-6545
Practice Address - Fax:480-726-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ444092Medicaid