Provider Demographics
NPI:1942893821
Name:PHAM, THI (RDH)
Entity Type:Individual
Prefix:MS
First Name:THI
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 QUANTRELL AVE APT 921
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2712
Mailing Address - Country:US
Mailing Address - Phone:301-920-4478
Mailing Address - Fax:
Practice Address - Street 1:915 N ST SE BLDG 175
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20374-5162
Practice Address - Country:US
Practice Address - Phone:202-433-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402207117124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist