MEDICARE: DR. DERYCK PHAM D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	052396-1	NY
2	122300000X	Dentist	02355500	NJ

General Provider Information

NPI Number	:	1023001922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DERYCK PHAM D.D.S.

Provider Business Mailing Address
First Line	:	447 S SHORE RD
Second Line	:
City	:	MARMORA
State	:	NJ
Zip	:	08223-1292
Country	:	US
Telephone Number	:	609-390-0111
Fax Number	:

Provider Business Practice Location Address
First Line	:	447 S SHORE RD
Second Line	:
City	:	MARMORA
State	:	NJ
Zip	:	08223-1292
Country	:	US
Telephone Number	:	609-390-0111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	08/09/2007

Similar Medicare Providers

1295755007 — MARMORA FAMILY DENTAL ASSOCIATES, PC
Practice Location Address:

447 ROUTE US 9 S
MARMORA, NJ
08223-1292

Practice Phone: 609-390-0111
Practice Fax: 609-390-0727

1306869953 — DR. ALBERT S HARRIS DMD
Practice Location Address:

447 ROUTE US 9 S
MARMORA, NJ
08223-1292

Practice Phone: 609-390-0111
Practice Fax: 609-390-0727

1679031322 — KALNIZ DENTAL PARTNERS OF NEW JERSEY PC
Practice Location Address:

447 S SHORE RD
MARMORA, NJ
08223-1292

Practice Phone: 312-800-1270
Practice Fax:

1124021068 — DR. DANIEL G LOGGI JR. DMD
Practice Location Address:

42 ROOSEVELT BLVD
MARMORA, NJ
08223-1402

Practice Phone: 609-390-0331
Practice Fax: 609-390-2602

1891782371 — HEMANG U DAVE M.D.
Practice Location Address:

210 S SHORE RD , SUITE 106
MARMORA, NJ
08223-1200

Practice Phone: 609-390-7888
Practice Fax: 609-390-2614

1639166101 — JULIANNE W CHILDS D.O.
Practice Location Address:

210 S SHORE RD , SUITE 106
MARMORA, NJ
08223-1200

Practice Phone: 609-390-7888
Practice Fax: 609-390-2614

Directions to “ DR. DERYCK PHAM D.D.S.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.