Provider Demographics
NPI:1154516649
Name:PHAM, THANG C (DDS)
Entity type:Individual
Prefix:DR
First Name:THANG
Middle Name:C
Last Name:PHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7640 AIRLINE DR
Mailing Address - Street 2:STE E
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77037-4620
Mailing Address - Country:US
Mailing Address - Phone:281-741-0545
Mailing Address - Fax:281-741-3135
Practice Address - Street 1:7640 AIRLINE DR
Practice Address - Street 2:STE E
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77037-4620
Practice Address - Country:US
Practice Address - Phone:281-741-0545
Practice Address - Fax:281-741-3135
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-08
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX260541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26054OtherTEXAS DENTAL LICENSE