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General NPI Number Information
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NPI Number | 1578975728
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Entity Type | Organization
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Legal Business Name | PHAM AND MAUSETH DDS INC
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 16918 DOVE CANYON RD STE 203
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City | SAN DIEGO
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State | CA
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Zip | 92127-3457
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Country | US
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Telephone | 858-451-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 16918 DOVE CANYON RD STE 203
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City | SAN DIEGO
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State | CA
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Zip | 92127-3457
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHIEU PHAM
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Credential |
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Telephone | 408-390-7228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State | CA
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