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General NPI Number Information
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NPI Number | 1326273210
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Entity Type | Individual
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Provider Name | TIANA HOANG THY PHAM D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/20/2009
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Last Update Date | 05/20/2009
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Provider Practice Location Address
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Address Line | 3101 DENTON HWY #100
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City | HALTOM CITY
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State | TX
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Zip | 76117
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Country | US
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Telephone | 817-831-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 2868 CONCHO TRAIL
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City | FORT WORTH
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State | TX
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Zip | 76118
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Country | US
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Telephone | 817-714-3211
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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 | 24554
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License Number State | TX
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