Healthcare Provider Details

I. General information

NPI: 1174592323
Provider Name (Legal Business Name): ALFRED PHEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 HILLTOP DR
REDDING CA
96002-0251
US

IV. Provider business mailing address

926 LEISHA LN
REDDING CA
96001-6203
US

V. Phone/Fax

Practice location:
  • Phone: 530-223-5500
  • Fax: 530-223-1790
Mailing address:
  • Phone: 916-708-6245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number46929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: