Provider Demographics
NPI:1205999497
Name:PHAM, BACH-MAI THI (DDS)
Entity type:Individual
Prefix:DR
First Name:BACH-MAI
Middle Name:THI
Last Name:PHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8171 BEYER CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4124
Mailing Address - Country:US
Mailing Address - Phone:916-682-0783
Mailing Address - Fax:
Practice Address - Street 1:5247 ELKHORN BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95842-2509
Practice Address - Country:US
Practice Address - Phone:916-344-2249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47155122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist