MEDICARE: PHAM PARADISE SMILES DENTISTRY, PC

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

General Provider Information

NPI Number	:	1801252325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHAM PARADISE SMILES DENTISTRY, PC

Provider Business Mailing Address
First Line	:	PO BOX 920050
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75392-0050
Country	:	US
Telephone Number	:	702-964-3626
Fax Number	:	702-425-9491

Provider Business Practice Location Address
First Line	:	3375 E TROPICANA AVE STE F8
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7357
Country	:	US
Telephone Number	:	702-964-3626
Fax Number	:	702-425-9491

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. QUYEN PHAM
Credential	:	DDS
Telephone Number	:	702-964-3626

Provider Enumeration Date	:	01/13/2016
Last Update Date	:	06/14/2022

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