Provider Demographics
NPI:1942452057
Name:GABRIELLA TN PHAM DDS INC
Entity Type:Organization
Organization Name:GABRIELLA TN PHAM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIELLA
Authorized Official - Middle Name:THANH-NGOC
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-245-9888
Mailing Address - Street 1:1640 E 1ST ST STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-6394
Mailing Address - Country:US
Mailing Address - Phone:714-245-9888
Mailing Address - Fax:
Practice Address - Street 1:1640 E 1ST ST STE C
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-6394
Practice Address - Country:US
Practice Address - Phone:714-245-9888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty