Healthcare Provider Details

I. General information

NPI: 1508552761
Provider Name (Legal Business Name): DANIELLE HA PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 N JOSEY LN STE 133
CARROLLTON TX
75007-5542
US

IV. Provider business mailing address

732 LEXINGTON AVE
COPPELL TX
75019-4526
US

V. Phone/Fax

Practice location:
  • Phone: 972-798-2644
  • Fax:
Mailing address:
  • Phone: 214-793-9787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42512
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: