Provider Demographics
NPI:1295081107
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:714-850-9999
Mailing Address - Street 1:891 BAKER ST
Mailing Address - Street 2:SUITE A12
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4361
Mailing Address - Country:US
Mailing Address - Phone:714-850-9999
Mailing Address - Fax:
Practice Address - Street 1:891 BAKER ST
Practice Address - Street 2:SUITE A12
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4361
Practice Address - Country:US
Practice Address - Phone:714-850-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-29
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA427611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty