=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225957368
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOAN PHAM DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2026
-----------------------------------------------------
Last Update Date | 07/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39 PARK LANE RD
-----------------------------------------------------
City | NEW MILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06776-2923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-350-2411
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 ABBEY LN UNIT 3409
-----------------------------------------------------
City | DANBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06810-5222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 669-350-4089
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 14819
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------