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General NPI Number Information
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NPI Number | 1699174532
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Entity Type | Individual
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Provider Name | MINH-AN LA-PHAM D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 08/15/2014
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Last Update Date | 12/13/2017
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Provider Practice Location Address
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Address Line | 9039 BOLSA AVE #103
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City | WESTMINSTER
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State | CA
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Zip | 92683-5572
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Country | US
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Telephone | 714-379-1322
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Fax |
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Provider Business Mailing Address
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Address Line | 46161 WESTLAKE DR STE 310
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City | STERLING
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State | VA
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Zip | 20165-5871
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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 |
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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 | 63918
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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 | 0401415325
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License Number State | VA
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