Provider Demographics
NPI:1851313290
Name:PHAM, KHANH (DDS)
Entity type:Individual
Prefix:DR
First Name:KHANH
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6655 S RURAL RD
Mailing Address - Street 2:STE 1
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3793
Mailing Address - Country:US
Mailing Address - Phone:480-831-5200
Mailing Address - Fax:
Practice Address - Street 1:6865 E BECKER LN STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6730
Practice Address - Country:US
Practice Address - Phone:480-998-8073
Practice Address - Fax:480-922-0560
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ58541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice