MEDICARE: DR. JESSICA T PHAM 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	36584	TX

General Provider Information

NPI Number	:	1518579226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA T PHAM DDS

Provider Business Mailing Address
First Line	:	3363 MCCUE RD APT 441
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-6762
Country	:	US
Telephone Number	:	361-463-1160
Fax Number	:

Provider Business Practice Location Address
First Line	:	4125 RICHMOND PKWY # 110
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-2508
Country	:	US
Telephone Number	:	281-560-3001
Fax Number	:

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

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	09/15/2023

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