Provider Demographics
NPI:1881002509
Name:PHAM, THI MINH (DDS)
Entity Type:Individual
Prefix:DR
First Name:THI
Middle Name:MINH
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 1:7400 SOUTHLAND BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-6971
Mailing Address - Country:US
Mailing Address - Phone:407-812-4511
Mailing Address - Fax:
Practice Address - Street 1:7400 SOUTHLAND BLVD STE 112
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-6971
Practice Address - Country:US
Practice Address - Phone:407-812-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist