Provider Demographics
NPI:1780801969
Name:PHAM, MAI-AN (DDS)
Entity type:Individual
Prefix:
First Name:MAI-AN
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 TURTLE CREEK BLVD
Mailing Address - Street 2:SUITE 1606
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5400
Mailing Address - Country:US
Mailing Address - Phone:214-284-4636
Mailing Address - Fax:
Practice Address - Street 1:9429 EL CENTRO DR STE 101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4960
Practice Address - Country:US
Practice Address - Phone:214-357-6377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222001223G0001X
CA575001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208645140OtherEIN