MEDICARE: DR. JACQUELINE PHAN DDS

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	122300000X	Dentist	39520	TX

General Provider Information

NPI Number	:	1346926748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE PHAN DDS

Provider Business Mailing Address
First Line	:	570 FM 156 S STE 100
Second Line	:
City	:	HASLET
State	:	TX
Zip	:	76052-3625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	570 FM 156 S STE 100
Second Line	:
City	:	HASLET
State	:	TX
Zip	:	76052-3625
Country	:	US
Telephone Number	:	817-663-1027
Fax Number	:

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

Provider Enumeration Date	:	06/22/2023
Last Update Date	:	12/07/2025

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Directions to “ DR. JACQUELINE PHAN DDS” Practice Location

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