MEDICARE: PHOUNG QUOC 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	1223G0001X	General Practice Dentistry	29084	TX

General Provider Information

NPI Number	:	1649610247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHOUNG QUOC PHAM DDS

Provider Business Mailing Address
First Line	:	12626 WOODFOREST BLVD # Z
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-3425
Country	:	US
Telephone Number	:	713-590-0999
Fax Number	:	173-590-1299

Provider Business Practice Location Address
First Line	:	5225 KATY FWY STE 104
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-2268
Country	:	US
Telephone Number	:	832-673-0999
Fax Number	:	281-657-2406

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

Provider Enumeration Date	:	06/27/2013
Last Update Date	:	06/27/2013

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