Provider Demographics
NPI:1427721976
Name:PHAM, TRANG (DMD)
Entity type:Individual
Prefix:DR
First Name:TRANG
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1678 FALLSWAY DR
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1804
Mailing Address - Country:US
Mailing Address - Phone:240-753-5508
Mailing Address - Fax:
Practice Address - Street 1:12150 HIGHWAY 17 BYP STE A
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-9343
Practice Address - Country:US
Practice Address - Phone:240-753-5508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014176181223G0001X
SCDGD.103331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice