Provider Demographics
NPI:1952771743
Name:DOWNTOWN SD MODERN DENTISTRY DENTAL GROUP
Entity Type:Organization
Organization Name:DOWNTOWN SD MODERN DENTISTRY DENTAL GROUP
Other - Org Name:DO AND PHAM DENTAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DO-YABUT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:619-850-2550
Mailing Address - Street 1:17000 RED HILL AVENUE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:435 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101
Practice Address - Country:US
Practice Address - Phone:619-850-2550
Practice Address - Fax:619-239-1355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty