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General NPI Number Information
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NPI Number | 1306200910
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Entity Type | Organization
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Legal Business Name | SHANNON PHAM & ASSOCIATES, DDS, PLLC
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Dates
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Enumeration Date | 04/09/2016
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Last Update Date | 04/09/2016
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Provider Practice Location Address
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Address Line | 20503 FM 529 RD SUITE 500
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City | CYPRESS
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State | TX
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Zip | 77433-3297
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Country | US
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Telephone | 281-789-8644
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Fax |
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Provider Business Mailing Address
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Address Line | 11611 CARSON FIELD LN
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City | CYPRESS
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State | TX
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Zip | 77433-2845
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Country | US
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Telephone | 832-273-5361
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SHANNON QUYNH PHAM
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Credential | DDS
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Telephone | 281-789-8644
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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 | 25646
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License Number State | TX
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