MEDICARE: DR. PETER NHAT VINH 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	29366	TX

General Provider Information

NPI Number	:	1720420250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER NHAT VINH PHAM D.D.S.

Provider Business Mailing Address
First Line	:	10207 LEWIS LN
Second Line	:
City	:	IOWA COLONY
State	:	TX
Zip	:	77583-5536
Country	:	US
Telephone Number	:	713-530-6827
Fax Number	:

Provider Business Practice Location Address
First Line	:	10207 LEWIS LN
Second Line	:
City	:	IOWA COLONY
State	:	TX
Zip	:	77583-5536
Country	:	US
Telephone Number	:	713-530-6827
Fax Number	:

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

Provider Enumeration Date	:	07/25/2013
Last Update Date	:	09/02/2021

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