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General NPI Number Information
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NPI Number | 1083005698
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Entity Type | Organization
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Legal Business Name | AMY H. PHAM, A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 02/18/2015
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Last Update Date | 02/18/2015
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Provider Practice Location Address
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Address Line | 2630 OLIVE HWY SUITE A
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City | OROVILLE
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State | CA
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Zip | 95966-6138
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Country | US
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Telephone | 530-534-6666
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Fax | 530-534-1040
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Provider Business Mailing Address
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Address Line | 2630 OLIVE HWY SUITE A
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City | OROVILLE
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State | CA
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Zip | 95966-6138
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Country | US
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Telephone | 530-534-6666
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Fax | 530-534-1040
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Authorized Official
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Title or Position | OWNER
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Name | MS. AMY H PHAM
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Credential | DDS
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Telephone | 530-534-6666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 52451
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License Number State | CA
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