MEDICARE: QUAN MINH 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	4277	NV

General Provider Information

NPI Number	:	1548423197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUAN MINH PHAM DDS

Provider Business Mailing Address
First Line	:	3600 CAMBRIDGE ST # 1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-4003
Country	:	US
Telephone Number	:	702-732-3600
Fax Number	:	702-369-9963

Provider Business Practice Location Address
First Line	:	3600 CAMBRIDGE ST # 1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-4003
Country	:	US
Telephone Number	:	702-732-3600
Fax Number	:	702-369-9963

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. QUAN MINH PHAM
Credential	:	D.D.S
Telephone Number	:	702-327-6685

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	07/03/2008

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