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General NPI Number Information
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NPI Number | 1538983267
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Entity Type | Organization
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Legal Business Name | ROGER V PHAM, D.D.S., INC.
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 9900 STOCKDALE HWY STE 201
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City | BAKERSFIELD
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State | CA
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Zip | 93311-3634
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Country | US
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Telephone | 661-664-9900
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Fax | 661-665-7918
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Provider Business Mailing Address
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Address Line | 9900 STOCKDALE HWY STE 201
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City | BAKERSFIELD
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State | CA
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Zip | 93311-3634
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Country | US
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Telephone | 661-664-9900
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Fax | 661-665-7918
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROGER VAN PHAM
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Credential | DDS
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Telephone | 714-603-1795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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