Provider Demographics
NPI:1851115596
Name:ROGER V. PHAM, D.D.S., A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:ROGER V. PHAM, D.D.S., A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-327-2189
Mailing Address - Street 1:5603 AUBURN ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-2979
Mailing Address - Country:US
Mailing Address - Phone:661-327-2189
Mailing Address - Fax:661-327-4350
Practice Address - Street 1:5603 AUBURN ST UNIT B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-2979
Practice Address - Country:US
Practice Address - Phone:661-327-2189
Practice Address - Fax:661-327-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental