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General NPI Number Information
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NPI Number | 1548780604
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Entity Type | Individual
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Provider Name | THI THI CONG PHAN DDS
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Gender | Female
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 06/21/2017
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Provider Practice Location Address
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Address Line | 2630 EL CAMINO REAL
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City | CARLSBAD
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State | CA
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Zip | 92008-1214
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Country | US
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Telephone | 760-434-1761
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Fax |
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Provider Business Mailing Address
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Address Line | 619 LANCASHIRE PL
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City | SAN MARCOS
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State | CA
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Zip | 92069-8108
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Country | US
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Telephone | 760-807-3669
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 49393
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License Number State | CA
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