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NPI Code Detail

MEDICARE: DR. MATTHEW TRAN PHAM DDS

MEDICARE: DR. MATTHEW TRAN 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
1122300000XDentist11018TN
2171000000XMilitary Health Care Provider
3122300000XDentist12549NC

General Provider Information

NPI Number : 1932689726
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW TRAN PHAM DDS
Provider Business Mailing Address
First Line : 1631 WETZEL AVE BLDG 815
Second Line :
City : FORT CARSON
State : CO
Zip : 80913-4095
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1111 S POLLOCK ST
Second Line :
City : SELMA
State : NC
Zip : 27576-2933
Country : US
Telephone Number : 919-965-2552
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2018
Last Update Date : 06/12/2024

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Directions to “ DR. MATTHEW TRAN PHAM DDS” Practice Location

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