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General NPI Number Information
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NPI Number | 1134508971
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Entity Type | Individual
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Provider Name | TRANG PHAM DDS
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Gender | Female
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Dates
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Enumeration Date | 05/27/2015
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Last Update Date | 09/12/2015
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Provider Practice Location Address
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Address Line | 2415 PACIFIC AVE SE
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City | OLYMPIA
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State | WA
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Zip | 98501-2065
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Country | US
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Telephone | 360-556-6040
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Fax |
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Provider Business Mailing Address
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Address Line | 2415 PACIFIC AVE SE
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City | OLYMPIA
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State | WA
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Zip | 98501-2065
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Country | US
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Telephone | 360-556-6040
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 62947
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License Number State | CA
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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 | 62947
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DE60576762
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License Number State | WA
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