Provider Demographics
NPI:1881984763
Name:PHAM, MARIA (DDS)
Entity type:Individual
Prefix:
First Name:MARIA
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 1:426 SINGLETON AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-7863
Mailing Address - Country:US
Mailing Address - Phone:510-588-1133
Mailing Address - Fax:510-340-7778
Practice Address - Street 1:426 SINGLETON AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-7863
Practice Address - Country:US
Practice Address - Phone:510-588-1133
Practice Address - Fax:510-340-7778
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist