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General NPI Number Information
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NPI Number | 1942596044
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Entity Type | Individual
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Provider Name | MARY-TUYEN PHAM DDS
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Gender | Female
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 07/06/2015
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Provider Practice Location Address
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Address Line | 3630 CENTRAL AVE SUITE 6
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City | RIVERSIDE
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State | CA
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Zip | 92506-5908
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Country | US
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Telephone | 951-682-1720
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 50431
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City | IRVINE
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State | CA
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Zip | 92619-0431
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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 |
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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 | 60030
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License Number State | CA
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