Healthcare Provider Details

I. General information

NPI: 1235685124
Provider Name (Legal Business Name): JANELLE PHAM COMFORT D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N TUSTIN AVE STE 102
SANTA ANA CA
92705-3535
US

IV. Provider business mailing address

1200 N TUSTIN AVE STE 102
SANTA ANA CA
92705-3535
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-2215
  • Fax:
Mailing address:
  • Phone: 714-835-2215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number103621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: