Provider Demographics
NPI:1811224843
Name:PHAN, DEAN HAI (PHARMD, DDS)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:HAI
Last Name:PHAN
Suffix:
Gender:M
Credentials:PHARMD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1756 BROAD PARK CIR N # 100
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7821
Mailing Address - Country:US
Mailing Address - Phone:817-453-2800
Mailing Address - Fax:
Practice Address - Street 1:1756 BROAD PARK CIR N # 100
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7821
Practice Address - Country:US
Practice Address - Phone:817-453-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX329301223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry