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General NPI Number Information
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NPI Number | 1306456702
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Entity Type | Individual
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Provider Name | KEVIN MINH-HUY PHAM DMD
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Gender | Male
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Dates
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Enumeration Date | 07/31/2020
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 344 NW LOOP 564 STE 400
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City | MINEOLA
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State | TX
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Zip | 75773-1128
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Country | US
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Telephone | 903-638-8287
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Fax |
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Provider Business Mailing Address
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Address Line | 12713 TANTARA DR
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City | AUSTIN
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State | TX
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Zip | 78729-6446
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Country | US
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Telephone | 512-947-3629
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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 | 61998
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 36470
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License Number State | TX
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