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General NPI Number Information
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NPI Number | 1760081129
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Entity Type | Organization
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Legal Business Name | ANTHONY PHAM DENTAL CORP
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Dates
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Enumeration Date | 10/17/2020
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Last Update Date | 10/17/2020
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Provider Practice Location Address
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Address Line | 2658 E GARVEY AVE S
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City | WEST COVINA
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State | CA
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Zip | 91791-2113
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Country | US
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Telephone | 626-967-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 13697 LOWELL ST
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City | EASTVALE
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State | CA
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Zip | 92880-3744
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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 | DENTIST
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Name | ANTHONY TUAN PHAM
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Credential | DDS
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Telephone | 951-582-1304
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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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