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General NPI Number Information
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NPI Number | 1790401941
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Entity Type | Individual
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Provider Name | ERIC VAN PHAM DMD
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Gender | Male
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Dates
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Enumeration Date | 10/18/2022
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 5603 AUBURN ST UNIT B
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City | BAKERSFIELD
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State | CA
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Zip | 93306-2979
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Country | US
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Telephone | 661-327-2189
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Fax | 661-327-4350
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Provider Business Mailing Address
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Address Line | 13442 FLOWER ST APT 5
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City | GARDEN GROVE
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State | CA
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Zip | 92843-6128
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Country | US
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Telephone | 714-603-1796
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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 | DDS107760
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License Number State | CA
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