MEDICARE: ANN PHAM D.D.S., P.C.

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	4078	NV

General Provider Information

NPI Number	:	1508059882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANN PHAM D.D.S., P.C.

Provider Business Mailing Address
First Line	:	8001 N DURANGO DR
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89143
Country	:	US
Telephone Number	:	702-456-0056
Fax Number	:	702-456-0052

Provider Business Practice Location Address
First Line	:	4210 W CRAIG RD
Second Line	:	SUITE #104
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2734
Country	:	US
Telephone Number	:	702-436-5222
Fax Number	:	702-873-5222

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANN T. A. PHAM
Credential	:	D.D.S.
Telephone Number	:	702-456-0056

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	08/21/2007

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