MEDICARE: DENTISTS OF OAKLAND PARK PA

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	:	1982334421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTISTS OF OAKLAND PARK PA

Provider Business Mailing Address
First Line	:	PO BOX 920050
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75392-0050
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:	303-952-0892

Provider Business Practice Location Address
First Line	:	620 E OAKLAND PARK BLVD
Second Line	:	SUITE 100
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334
Country	:	US
Telephone Number	:	754-206-5897
Fax Number	:	754-208-5271

Authorized Official
Title or Position	:	OWNER
Name	:	MINH PHAM
Credential	:	DDS
Telephone Number	:	754-206-5897

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	06/16/2022

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Directions to “DENTISTS OF OAKLAND PARK PA ” Practice Location

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