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General NPI Number Information
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NPI Number | 1346636263
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Entity Type | Organization
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Legal Business Name | PHAM WALTER PLLC
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Dates
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Enumeration Date | 04/07/2015
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 12138 MUKILTEO SPEEDWAY STE 301
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City | MUKILTEO
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State | WA
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Zip | 98275-5738
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Country | US
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Telephone | 425-347-4141
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Fax |
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Provider Business Mailing Address
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Address Line | 12138 MUKILTEO SPEEDWAY STE 301
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City | MUKILTEO
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State | WA
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Zip | 98275-5738
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Country | US
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Telephone | 425-347-4141
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MATTHEW HERNANDEZ
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Credential |
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Telephone | 425-347-4141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE00008539
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License Number State | WA
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