Provider Demographics
NPI:1821159096
Name:PHAM, GEM T (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEM
Middle Name:T
Last Name:PHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14539 ARROYO HONDO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3640
Mailing Address - Country:US
Mailing Address - Phone:858-385-9295
Mailing Address - Fax:858-385-9298
Practice Address - Street 1:15708 POMERADO RD
Practice Address - Street 2:SUITE N 103
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2066
Practice Address - Country:US
Practice Address - Phone:858-385-9295
Practice Address - Fax:858-385-9298
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44760122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist