=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265287452
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NHI PHAM DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2024
-----------------------------------------------------
Last Update Date | 11/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 S INDIANA AVE
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34223-3764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-475-3962
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6340 N WICKHAM RD UNIT 101
-----------------------------------------------------
City | MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32940-2045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 29267
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 61607879
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------