Healthcare Provider Details

I. General information

NPI: 1316047798
Provider Name (Legal Business Name): NGHI TRINH-PHAM D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 CENTER ST W
ROSEAU MN
56751-1419
US

IV. Provider business mailing address

308 CENTER ST W
ROSEAU MN
56751-1419
US

V. Phone/Fax

Practice location:
  • Phone: 218-463-1070
  • Fax:
Mailing address:
  • Phone: 218-463-1070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD13633
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18162
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: