Provider Demographics
NPI:1336148030
Name:PHAM, THOMAS T (DMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:T
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 1:14665 SW MILLIKAN WAY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-2999
Mailing Address - Country:US
Mailing Address - Phone:503-641-2200
Mailing Address - Fax:503-641-2220
Practice Address - Street 1:14665 SW MILLIKAN WAY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003
Practice Address - Country:US
Practice Address - Phone:503-641-2200
Practice Address - Fax:503-641-2220
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8300122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist