Provider Demographics
NPI:1790098812
Name:PHAM, SHANNON QUYNH (DDS)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:QUYNH
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 1:11611 CARSON FIELD LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2845
Mailing Address - Country:US
Mailing Address - Phone:832-273-5361
Mailing Address - Fax:
Practice Address - Street 1:20503 FM 529 RD
Practice Address - Street 2:SUITE 500
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-3297
Practice Address - Country:US
Practice Address - Phone:281-789-8644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-18
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00256461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice