Provider Demographics
NPI:1962661744
Name:PHAM, SON NGOC (DDS)
Entity Type:Individual
Prefix:DR
First Name:SON
Middle Name:NGOC
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 1:565 CONTRA COSTA BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1259
Mailing Address - Country:US
Mailing Address - Phone:925-451-6501
Mailing Address - Fax:
Practice Address - Street 1:565 CONTRA COSTA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1259
Practice Address - Country:US
Practice Address - Phone:925-689-2748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA538501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice