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General NPI Number Information
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NPI Number | 1750951505
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Entity Type | Individual
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Provider Name | NIKOLE MY-HUYEN PHAM DMD
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Gender | Female
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Dates
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Enumeration Date | 06/24/2021
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 1654 GRIFFIN RD
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City | APO
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State | AA
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Zip | 92277
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Country | US
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Telephone | 251-458-1771
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Fax |
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Provider Business Mailing Address
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Address Line | 2695 MAJESTIC WAY
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City | PALM SPRINGS
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State | CA
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Zip | 92262-2144
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Country | US
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Telephone | 251-458-1771
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D-0006918-C1
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D-0006918-C1
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 10042
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License Number State | AL
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