Healthcare Provider Details

I. General information

NPI: 1609553387
Provider Name (Legal Business Name): HIEU MICHAEL PHAM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9774 WASHINGTON ST
THORNTON CO
80229-2162
US

IV. Provider business mailing address

1500 N GRANT ST STE N
DENVER CO
80203-1859
US

V. Phone/Fax

Practice location:
  • Phone: 303-256-9610
  • Fax:
Mailing address:
  • Phone: 720-912-7720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDEN.00206546
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: