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General NPI Number Information
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NPI Number | 1528985157
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Entity Type | Individual
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Provider Name | SPENCER QUOC-TAI PHAM
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Gender | Male
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Dates
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Enumeration Date | 07/03/2026
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Last Update Date | 07/03/2026
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Provider Practice Location Address
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Address Line | 3838 BRIDGEPORT WAY W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4416
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Country | US
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Telephone | 253-212-3430
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Fax |
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Provider Business Mailing Address
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Address Line | 53 FLORHAM PARK DR
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City | SPRING
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State | TX
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Zip | 77379-3659
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Country | US
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Telephone | 832-515-5656
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 42573
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License Number State | TX
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