Healthcare Provider Details

I. General information

NPI: 1003375965
Provider Name (Legal Business Name): PHAMOUS SMILES FAMILY DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 W RAY RD STE 1
CHANDLER AZ
85224-3557
US

IV. Provider business mailing address

2136 E LA VIEVE LN
TEMPE AZ
85284-3542
US

V. Phone/Fax

Practice location:
  • Phone: 480-899-5240
  • Fax:
Mailing address:
  • Phone: 480-216-2181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. CHAU M PHAM
Title or Position: PRESIDENT & CEO
Credential: DMD
Phone: 480-216-2181