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NPI Code Detail

MEDICARE: DR. MARY REGINA PHAM D.D.S., M.S.

MEDICARE: DR. MARY REGINA PHAM D.D.S., M.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
11223P0221XPediatric Dentistry60222CA

General Provider Information

NPI Number : 1316188030
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY REGINA PHAM D.D.S., M.S.
Provider Business Mailing Address
First Line : 1041 E YORBA LINDA BLVD STE 206
Second Line :
City : PLACENTIA
State : CA
Zip : 92870-3760
Country : US
Telephone Number : 714-528-8252
Fax Number :
Provider Business Practice Location Address
First Line : 1041 E YORBA LINDA BLVD STE 206
Second Line :
City : PLACENTIA
State : CA
Zip : 92870-3760
Country : US
Telephone Number : 714-528-8252
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2009
Last Update Date : 12/22/2020

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