Provider Demographics
NPI:1891714192
Name:PHAM, THOMAS T (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
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 1:18731 N REEMS RD
Mailing Address - Street 2:STE. 600
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8644
Mailing Address - Country:US
Mailing Address - Phone:623-544-4555
Mailing Address - Fax:623-544-4547
Practice Address - Street 1:18731 N REEMS RD
Practice Address - Street 2:STE. 600
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8644
Practice Address - Country:US
Practice Address - Phone:623-544-4555
Practice Address - Fax:623-544-4547
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ52611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice