Provider Demographics
NPI:1912018235
Name:PHAM, ROBERT NGOC (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NGOC
Last Name:PHAM
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:1501 STONECREEK DR S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9838
Mailing Address - Country:US
Mailing Address - Phone:614-866-3411
Mailing Address - Fax:614-866-2455
Practice Address - Street 1:1501 STONECREEK DR S
Practice Address - Street 2:SUITE 102
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9838
Practice Address - Country:US
Practice Address - Phone:614-866-3411
Practice Address - Fax:614-866-2455
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-08-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH211301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics