MEDICARE: MAI T. PHAN, D.M.D., P.C.

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	19603	MA

General Provider Information

NPI Number	:	1932367489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAI T. PHAN, D.M.D., P.C.

Provider Business Mailing Address
First Line	:	30 SPRINGDALE AVE
Second Line	:	P.O. BOX 726
City	:	DOVER
State	:	MA
Zip	:	02030-2374
Country	:	US
Telephone Number	:	508-785-0356
Fax Number	:	508-785-0974

Provider Business Practice Location Address
First Line	:	30 SPRINGDALE AVE
Second Line	:
City	:	DOVER
State	:	MA
Zip	:	02030-2374
Country	:	US
Telephone Number	:	508-785-0356
Fax Number	:	508-785-0974

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MAI T PHAN
Credential	:	DMD
Telephone Number	:	508-785-0356

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	05/30/2008

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