Provider Demographics
NPI:1962792887
Name:MATTHEWS, MY PHUONG PHAM (DDS)
Entity type:Individual
Prefix:DR
First Name:MY
Middle Name:PHUONG PHAM
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 W FRONTIER PKWY, STE 150
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078
Mailing Address - Country:US
Mailing Address - Phone:469-649-1130
Mailing Address - Fax:469-649-1131
Practice Address - Street 1:1640 W FRONTIER PKWY SUITE 150
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2625
Practice Address - Country:US
Practice Address - Phone:469-649-1130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX284161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry