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General NPI Number Information
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NPI Number | 1871822486
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Entity Type | Organization
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Legal Business Name | MICHAEL TUNG PHAM, DMD, PC
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 12/10/2009
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Provider Practice Location Address
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Address Line | 5905 S EASTERN AVE SUITE 112
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City | LAS VEGAS
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State | NV
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Zip | 89119-3129
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Country | US
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Telephone | 702-262-5693
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Fax |
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Provider Business Mailing Address
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Address Line | 5905 S EASTERN AVE SUITE 112
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City | LAS VEGAS
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State | NV
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Zip | 89119-3129
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Country | US
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Telephone | 702-262-5693
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Fax |
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Authorized Official
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Title or Position | DENTIST/PRESIDENT/OWNER
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Name | DR. MICHAEL TUNG PHAM
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Credential | DMD
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Telephone | 702-262-5693
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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 | 4769
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License Number State | NV
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