MEDICARE: DR. CHRISTIAN ALEXANDER PHAM D.M.D

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	1223G0001X	General Practice Dentistry	5342	NV
2	1223G0001X	General Practice Dentistry	55297	CA
3	1223G0001X	General Practice Dentistry	21258	MA
4	1223G0001X	General Practice Dentistry	32794	TX

General Provider Information

NPI Number	:	1427060920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTIAN ALEXANDER PHAM D.M.D

Provider Business Mailing Address
First Line	:	6827 CAMP BULLIS RD STE 302
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256-1730
Country	:	US
Telephone Number	:	210-538-7500
Fax Number	:	210-569-7750

Provider Business Practice Location Address
First Line	:	6827 CAMP BULLIS RD STE 302
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256-1730
Country	:	US
Telephone Number	:	210-538-7500
Fax Number	:	210-569-7750

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	12/24/2020

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