Healthcare Provider Details

I. General information

NPI: 1174168264
Provider Name (Legal Business Name): SD CORPUS CHRISTI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 MORGAN AVE
CORPUS CHRISTI TX
78404-3348
US

IV. Provider business mailing address

3543 ROOSEVELT AVE
SAN ANTONIO TX
78214-2832
US

V. Phone/Fax

Practice location:
  • Phone: 361-884-6106
  • Fax: 361-884-9538
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: 214-466-1400