Provider Demographics
NPI:1871822486
Name:MICHAEL TUNG PHAM, DMD, PC
Entity Type:Organization
Organization Name:MICHAEL TUNG PHAM, DMD, PC
Other - Org Name:EASTERN HILLS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL TUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-262-5693
Mailing Address - Street 1:5905 S EASTERN AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-3129
Mailing Address - Country:US
Mailing Address - Phone:702-262-5693
Mailing Address - Fax:
Practice Address - Street 1:5905 S EASTERN AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3129
Practice Address - Country:US
Practice Address - Phone:702-262-5693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV47691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty