MEDICARE: ANN PHAM D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4078	NV

General Provider Information

NPI Number	:	1154420818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN PHAM D.D.S.

Provider Business Mailing Address
First Line	:	4210 W CRAIG RD
Second Line	:	SUITE 104
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2734
Country	:	US
Telephone Number	:	702-436-5222
Fax Number	:	702-873-5222

Provider Business Practice Location Address
First Line	:	4210 W CRAIG RD
Second Line	:	SUITE 104
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2734
Country	:	US
Telephone Number	:	702-436-5222
Fax Number	:	702-873-5222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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Directions to “ ANN PHAM D.D.S.” Practice Location

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