MEDICARE: QUEANH PHAN DMD PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1639008139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEANH PHAN DMD PLLC

Provider Business Mailing Address
First Line	:	8855 IMMOKALEE RD UNIT 10
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34120-3928
Country	:	US
Telephone Number	:	239-348-3079
Fax Number	:	239-348-2338

Provider Business Practice Location Address
First Line	:	8855 IMMOKALEE RD UNIT 10
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34120-3928
Country	:	US
Telephone Number	:	239-348-3079
Fax Number	:	239-348-2338

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. QUEANH PHAN
Credential	:	DMD
Telephone Number	:	239-250-3445

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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