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General NPI Number Information
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NPI Number | 1881378776
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Entity Type | Individual
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Provider Name | YEN HUYNH PHAN DMD
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Gender | Female
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 950 AMERICAN LEGION HWY
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City | ROSLINDALE
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State | MA
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Zip | 02131-4701
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Country | US
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Telephone | 617-335-8232
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Fax | 617-323-3003
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Provider Business Mailing Address
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Address Line | 91 BABSON ST APT 1
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City | BOSTON
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State | MA
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Zip | 02126-2489
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Country | US
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Telephone | 617-858-4529
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1859784
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License Number State | MA
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