MEDICARE: QUYEN MANH PHAM DDS

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	46925	CA
2	122300000X	Dentist	5042	NV

General Provider Information

NPI Number	:	1225113897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUYEN MANH PHAM DDS

Provider Business Mailing Address
First Line	:	3375 E TROPICANA AVE
Second Line	:	SUITE F-8
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7388
Country	:	US
Telephone Number	:	702-964-3626
Fax Number	:	702-425-9491

Provider Business Practice Location Address
First Line	:	3375 E TROPICANA AVE
Second Line	:	STE F-8
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7388
Country	:	US
Telephone Number	:	702-964-3626
Fax Number	:	702-425-9491

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	04/07/2016

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