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General NPI Number Information
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NPI Number | 1639254295
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Entity Type | Individual
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Provider Name | MICHELLE MARTINEZ PHAM DDS
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 545 MARKS ST
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City | HENDERSON
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State | NV
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Zip | 89014-6500
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Country | US
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Telephone | 702-425-3697
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Fax | 702-450-6539
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Provider Business Mailing Address
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Address Line | 545 MARKS ST
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City | HENDERSON
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State | NV
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Zip | 89014-6500
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Country | US
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Telephone | 702-425-3697
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Fax | 702-450-6539
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 45733
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5004
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License Number State | NV
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