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General NPI Number Information
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NPI Number | 1053852319
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Entity Type | Organization
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Legal Business Name | DENNIS H. PHAM DDS DENTAL CORPORATION
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 47875 CALEO BAY DR A101
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City | LA QUINTA
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State | CA
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Zip | 92253-6386
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Country | US
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Telephone | 760-564-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 47875 CALEO BAY DR A101
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City | LA QUINTA
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State | CA
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Zip | 92253-6386
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Country | US
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Telephone | 760-564-1300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENNIS PHAM
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Credential | DDS
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Telephone | 720-935-5704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 100207
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License Number State | CA
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