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General NPI Number Information
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NPI Number | 1548629694
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Entity Type | Organization
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Legal Business Name | THE T. PHAN, DDS, MD PROFESSIONAL CORP
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 1620 NEWBURY RD STE 5
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City | NEWBURY PARK
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State | CA
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Zip | 91320-3401
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Country | US
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Telephone | 805-600-4540
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Fax | 805-456-0768
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Provider Business Mailing Address
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Address Line | 1620 NEWBURY RD STE 5
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City | NEWBURY PARK
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State | CA
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Zip | 91320-3401
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Country | US
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Telephone | 805-600-4540
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Fax | 805-456-0768
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. BRITTANY WHARTON
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Credential |
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Telephone | 805-600-4540
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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 | 55427
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License Number State | CA
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