Provider Demographics
NPI:1649610247
Name:PHAM, PHOUNG QUOC (DDS)
Entity type:Individual
Prefix:
First Name:PHOUNG
Middle Name:QUOC
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 1:12626 WOODFOREST BLVD # Z
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-3425
Mailing Address - Country:US
Mailing Address - Phone:713-590-0999
Mailing Address - Fax:173-590-1299
Practice Address - Street 1:5225 KATY FWY STE 104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2268
Practice Address - Country:US
Practice Address - Phone:832-673-0999
Practice Address - Fax:281-657-2406
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX290841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice