Provider Demographics
NPI:1700909975
Name:ROBERT PHAM DDS A PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:ROBERT PHAM DDS A PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NHAN
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-985-5158
Mailing Address - Street 1:5516 BOULDER HWY
Mailing Address - Street 2:STE. 2A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-6000
Mailing Address - Country:US
Mailing Address - Phone:702-985-5158
Mailing Address - Fax:702-547-2232
Practice Address - Street 1:55 E. HORIZON RIDGE PKWY.
Practice Address - Street 2:STE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002
Practice Address - Country:US
Practice Address - Phone:702-436-2232
Practice Address - Fax:702-436-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty