=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033416250
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TL PHAM, P.A., DBA HAPPY SMILES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2011
-----------------------------------------------------
Last Update Date | 03/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7640 AIRLINE DR UNIT E
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77037-4621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-741-0545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4903 CANTERBURY WAY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77069-2135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-286-4550
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL DENTIST
-----------------------------------------------------
Name | DR. THANG CHI PHAM
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 713-447-0745
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 26054
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------