Healthcare Provider Details

I. General information

NPI: 1750951505
Provider Name (Legal Business Name): NIKOLE MY-HUYEN PHAM DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 08/07/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1654 GRIFFIN RD
APO AA
92277
US

IV. Provider business mailing address

2695 MAJESTIC WAY
PALM SPRINGS CA
92262-2144
US

V. Phone/Fax

Practice location:
  • Phone: 251-458-1771
  • Fax:
Mailing address:
  • Phone: 251-458-1771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD-0006918-C1
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD-0006918-C1
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number10042
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: