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General NPI Number Information
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NPI Number | 1811134620
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Entity Type | Organization
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Legal Business Name | PHAM & LUCAS ENTERPRISES, INC
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Dates
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Enumeration Date | 01/15/2009
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Last Update Date | 01/15/2009
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Provider Practice Location Address
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Address Line | 8240 ANTOINE DR 206
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City | HOUSTON
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State | TX
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Zip | 77088-2534
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Country | US
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Telephone | 281-741-7400
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Fax | 281-741-7406
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Provider Business Mailing Address
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Address Line | PO BOX 38602
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City | HOUSTON
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State | TX
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Zip | 77238-8602
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Country | US
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Telephone | 281-741-7400
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Fax | 281-741-7406
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Authorized Official
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Title or Position | OWNER
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Name | DIEP T PHAM
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Credential | DDS
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Telephone | 281-741-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 17862
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License Number State | TX
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