Healthcare Provider Details

I. General information

NPI: 1427047638
Provider Name (Legal Business Name): PHUONG-GIANG THI PHAM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 7TH ST W
SAINT PAUL MN
55102-3828
US

IV. Provider business mailing address

1026 7TH ST W
ST. PAUL MN
55102
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-1110
  • Fax: 651-241-1127
Mailing address:
  • Phone: 651-241-1110
  • Fax: 651-241-1127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD11831
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD11831
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: