Provider Demographics
NPI:1780067538
Name:PHAM, TAN (DDS)
Entity type:Individual
Prefix:DR
First Name:TAN
Middle Name:
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 1:17922 AVALON POINT CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5267
Mailing Address - Country:US
Mailing Address - Phone:626-383-2842
Mailing Address - Fax:
Practice Address - Street 1:636 HIGHWAY 6
Practice Address - Street 2:SUITE 700
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-5141
Practice Address - Country:US
Practice Address - Phone:281-240-3210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice