Provider Demographics
NPI:1972228831
Name:PHAM, ANDREW CHRISTOPHER (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:CHRISTOPHER
Last Name:PHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14730 SE FRYE ST
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-2837
Mailing Address - Country:US
Mailing Address - Phone:971-533-9161
Mailing Address - Fax:
Practice Address - Street 1:712 JAY ST
Practice Address - Street 2:
Practice Address - City:FOSSIL
Practice Address - State:OR
Practice Address - Zip Code:97830-8371
Practice Address - Country:US
Practice Address - Phone:541-723-2725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD116001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice