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General NPI Number Information
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NPI Number | 1538427745
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Entity Type | Organization
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Legal Business Name | MARK PHAM, DMD, PC
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 57 OBERY ST SUITE 2
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City | PLYMOUTH
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State | MA
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Zip | 02360-2480
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Country | US
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Telephone | 617-820-6447
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Fax |
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Provider Business Mailing Address
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Address Line | 57 OBERY ST SUITE 2
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City | PLYMOUTH
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State | MA
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Zip | 02360
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Country | US
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Telephone | 617-820-6447
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MARK PHAM
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Credential | D.M.D.
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Telephone | 617-820-6447
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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 | DN21073
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License Number State | MA
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