Healthcare Provider Details

I. General information

NPI: 1912934167
Provider Name (Legal Business Name): THUAN N PHAM D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 SWISHER ROAD
HICKORY CREEK TX
75065
US

IV. Provider business mailing address

3972 SPINNAKER RUN PT
LITTLE ELM TX
75068-3110
US

V. Phone/Fax

Practice location:
  • Phone: 972-999-7342
  • Fax:
Mailing address:
  • Phone: 972-999-7342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22284
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: