Healthcare Provider Details

I. General information

NPI: 1760760813
Provider Name (Legal Business Name): VANTHI PHAM, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15561 BROOKHURST ST
WESTMINSTER CA
92683-7554
US

IV. Provider business mailing address

15561 BROOKHURST ST
WESTMINSTER CA
92683-7554
US

V. Phone/Fax

Practice location:
  • Phone: 714-531-6200
  • Fax: 714-531-6262
Mailing address:
  • Phone: 714-531-6200
  • Fax: 714-531-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number45518
License Number StateCA

VIII. Authorized Official

Name: VANTHI PHAM
Title or Position: DENTIST
Credential:
Phone: 714-531-6200