MEDICARE: PHAN DENTAL CORPORATION PC

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
2	1223P0700X	Prosthodontics

General Provider Information

NPI Number	:	1437091634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHAN DENTAL CORPORATION PC

Provider Business Mailing Address
First Line	:	150 N JACKSON AVE STE 211
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95116-1908
Country	:	US
Telephone Number	:	408-251-7901
Fax Number	:

Provider Business Practice Location Address
First Line	:	995 MONTAGUE EXPY STE 116
Second Line	:
City	:	MILPITAS
State	:	CA
Zip	:	95035-6827
Country	:	US
Telephone Number	:	408-259-7900
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JANET NEGRETE
Credential	:
Telephone Number	:	408-251-7901

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “PHAN DENTAL CORPORATION PC ” Practice Location

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