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General NPI Number Information
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NPI Number | 1164820130
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Entity Type | Organization
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Legal Business Name | JOSEPH PHEN, DENTIST, A DENTAL CORPORATION
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 12/08/2014
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Provider Practice Location Address
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Address Line | 8351 ELK GROVE BLVD STE 300
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City | ELK GROVE
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State | CA
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Zip | 95758-5515
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Country | US
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Telephone | 916-691-6997
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Fax |
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Provider Business Mailing Address
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Address Line | 8351 ELK GROVE BLVD STE 300
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City | ELK GROVE
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State | CA
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Zip | 95758-5515
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Country | US
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Telephone | 916-691-6997
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | JOSEPH PHEN
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Credential | D.D.S.
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Telephone | 916-691-6997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 45172
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License Number State | CA
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