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General NPI Number Information
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NPI Number | 1073174637
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Entity Type | Individual
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Provider Name | HUONG THU PHAN DMD
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Gender | Female
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 2300 W BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43204-3783
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Country | US
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Telephone | 614-645-2300
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Fax | 614-645-5517
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Provider Business Mailing Address
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Address Line | 4419 FALLBROOK BLVD
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City | PALM HARBOR
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State | FL
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Zip | 34685-2653
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Country | US
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Telephone | 813-420-7005
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | APP-000261372
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN25552
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License Number State | FL
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