MEDICARE: MICHAEL PHAM, DDS, MS, INC

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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1427702836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL PHAM, DDS, MS, INC

Provider Business Mailing Address
First Line	:	2801 WATERMAN BLVD STE 290
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-2972
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 WATERMAN BLVD STE 290
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-2972
Country	:	US
Telephone Number	:	707-425-5666
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL ANTHONY YTOAN PHAM
Credential	:	DDS
Telephone Number	:	707-425-5666

Provider Enumeration Date	:	02/05/2022
Last Update Date	:	02/16/2023

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