Healthcare Provider Details

I. General information

NPI: 1609323948
Provider Name (Legal Business Name): QUYNHNHU PHAM DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4288 OKEECHOBEE BLVD
WEST PALM BEACH FL
33409-3206
US

IV. Provider business mailing address

4288 OKEECHOBEE BLVD
WEST PALM BEACH FL
33409-3206
US

V. Phone/Fax

Practice location:
  • Phone: 713-499-9890
  • Fax:
Mailing address:
  • Phone: 713-499-9890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN22702
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number058818
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN22702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: