Healthcare Provider Details

I. General information

NPI: 1619666898
Provider Name (Legal Business Name): SD PARK ROW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W PARK ROW DR
ARLINGTON TX
76013-3904
US

IV. Provider business mailing address

PO BOX 453247
GARLAND TX
75045-3247
US

V. Phone/Fax

Practice location:
  • Phone: 817-784-7888
  • Fax:
Mailing address:
  • Phone: 214-466-1400
  • Fax: 214-367-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. LYNHTHY T PHAM
Title or Position: OWNER
Credential: DDS
Phone: 469-902-6792