Healthcare Provider Details

I. General information

NPI: 1154245546
Provider Name (Legal Business Name): ANH NGOC LAN PHAM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SUMMIT AVE
GREENSBORO NC
27405-7918
US

IV. Provider business mailing address

220 TARHEEL DR
ARCHDALE NC
27263-3230
US

V. Phone/Fax

Practice location:
  • Phone: 336-370-1112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14947
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: