Provider Demographics
NPI:1861832941
Name:PHAN, QUEANH N (DMD)
Entity Type:Individual
Prefix:DR
First Name:QUEANH
Middle Name:N
Last Name:PHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8855 IMMOKALEE ROAD
Mailing Address - Street 2:SUITE #10
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-2407
Mailing Address - Country:US
Mailing Address - Phone:239-250-3445
Mailing Address - Fax:
Practice Address - Street 1:8855 IMMOKALEE RD
Practice Address - Street 2:SUITE 10
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119
Practice Address - Country:US
Practice Address - Phone:239-250-3445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20228122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist