MEDICARE: DENTISTS AT MIDTOWN, PA

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

General Provider Information

NPI Number	:	1548728819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTISTS AT MIDTOWN, PA

Provider Business Mailing Address
First Line	:	PO BOX 920050
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75392-0050
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:	949-474-1495

Provider Business Practice Location Address
First Line	:	3120 N MIAMI AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33127-3718
Country	:	US
Telephone Number	:	786-724-0418
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DDS
Name	:	DR. MINH B. PHAM
Credential	:	DDS
Telephone Number	:	786-724-0418

Provider Enumeration Date	:	03/06/2019
Last Update Date	:	04/13/2022

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