Provider Demographics
NPI:1750951505
Name:PHAM, NIKOLE MY-HUYEN (DMD)
Entity type:Individual
Prefix:DR
First Name:NIKOLE
Middle Name:MY-HUYEN
Last Name:PHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8930 BROWN DR BLDG 9, 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-4341
Mailing Address - Country:US
Mailing Address - Phone:251-458-1771
Mailing Address - Fax:
Practice Address - Street 1:8930 BROWN DR BLDG 9, 2ND FLOOR
Practice Address - Street 2:ROOM 2505
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-4341
Practice Address - Country:US
Practice Address - Phone:251-458-1771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-0006918-C1122300000X
AL10042171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No122300000XDental ProvidersDentist