MEDICARE: DR. KATHLEEN CAMLAI PHAM DELA PAZ DDS

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	18800	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871543496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN CAMLAI PHAM DELA PAZ DDS

Provider Business Mailing Address
First Line	:	26314 BOLTON TRAILS LN
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-3788
Country	:	US
Telephone Number	:	713-292-6302
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 ROOKIN ST UNIT A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-5019
Country	:	US
Telephone Number	:	713-273-3700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/15/2022

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