Healthcare Provider Details

I. General information

NPI: 1558364208
Provider Name (Legal Business Name): TUAN D PHAM DMD & JOSEPH A MALONEY DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 OLD WASHINGTON RD STE 204
WALDORF MD
20602-3250
US

IV. Provider business mailing address

3450 OLD WASHINGTON RD STE 204
WALDORF MD
20602-3250
US

V. Phone/Fax

Practice location:
  • Phone: 301-374-9033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13053
License Number StateMD

VIII. Authorized Official

Name: TUAN PHAM
Title or Position: OWNER
Credential: D.M.D.
Phone: 301-374-9033