Provider Demographics
NPI:1881003135
Name:PHAN, PHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHI
Middle Name:
Last Name:PHAN
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 1:6910 S CIMARRON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2280
Mailing Address - Country:US
Mailing Address - Phone:702-805-4555
Mailing Address - Fax:702-500-0416
Practice Address - Street 1:6910 S CIMARRON RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2280
Practice Address - Country:US
Practice Address - Phone:702-805-4555
Practice Address - Fax:702-500-0416
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV65331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice