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General NPI Number Information
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NPI Number | 1336315688
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Entity Type | Organization
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Legal Business Name | THANH K PHAM DDS INC.
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 355 EAST 21ST STE B
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City | SAN BERNARDINO
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State | CA
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Zip | 92404
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Country | US
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Telephone | 909-881-5787
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Fax | 909-881-6855
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Provider Business Mailing Address
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Address Line | 355 EAST 21ST STE B
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City | SAN BERNARDINO
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State | CA
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Zip | 92404
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Country | US
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Telephone | 909-881-5787
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Fax | 909-881-6855
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Authorized Official
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Title or Position | DENTIST
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Name | THANH K PHAM
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Credential | DDS
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Telephone | 909-887-5787
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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 | 44352
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License Number State | CA
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