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General NPI Number Information
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NPI Number | 1669159299
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Entity Type | Organization
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Legal Business Name | SOUTHERN SMILES, PA
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Dates
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Enumeration Date | 07/05/2023
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Last Update Date | 07/15/2023
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Provider Practice Location Address
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Address Line | 8421 FM 521 RD SUITE F
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City | ROSHARON
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State | TX
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Zip | 77583
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Country | US
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Telephone | 281-369-5569
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Fax | 281-369-5150
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Provider Business Mailing Address
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Address Line | PO BOX 20073
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City | SUGAR LAND
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State | TX
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Zip | 77496-0073
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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 | FOUNDER
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Name | DR. PHI TRONG PHAM
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Credential | DDS
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Telephone | 757-277-2569
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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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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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