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General NPI Number Information
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NPI Number | 1730813429
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Entity Type | Individual
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Provider Name | STEVEN MINH PHUNG DMD
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Gender | Male
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | LEFLER DENTAL CLINIC
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City | JOINT BASE LEWIS MCCHORD
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State | WA
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Zip | 98433
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Country | US
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Telephone | 253-967-4505
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Fax |
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Provider Business Mailing Address
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Address Line | 4275 S PINE ST APT A311
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City | TACOMA
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State | WA
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Zip | 98409-6580
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Country | US
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Telephone | 714-386-0323
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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 | DN27104
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License Number State | FL
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