Healthcare Provider Details

I. General information

NPI: 1780521914
Provider Name (Legal Business Name): ANH PHAN DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6458 TUPELO DR STE A
CITRUS HEIGHTS CA
95621-1704
US

IV. Provider business mailing address

PO BOX 8068
CITRUS HEIGHTS CA
95621-8068
US

V. Phone/Fax

Practice location:
  • Phone: 916-722-2273
  • Fax:
Mailing address:
  • Phone: 916-722-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ANH PHAN
Title or Position: OWNER
Credential: DMD
Phone: 916-722-2273