MEDICARE: PAULINE PHAM 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	122300000X	Dentist	7129	LA

General Provider Information

NPI Number	:	1902417942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULINE PHAM DDS

Provider Business Mailing Address
First Line	:	4758 SHERWOOD DR
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70128-3118
Country	:	US
Telephone Number	:	504-722-0545
Fax Number	:

Provider Business Practice Location Address
First Line	:	10129 CROSSING WAY STE 400
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-5892
Country	:	US
Telephone Number	:	225-788-1400
Fax Number	:

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

Provider Enumeration Date	:	08/13/2020
Last Update Date	:	08/13/2020

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Directions to “ PAULINE PHAM DDS” Practice Location

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