Provider Demographics
NPI:1962912758
Name:PHAM, PAUL N (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:N
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 1:6539 BRENTFIELD CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-2273
Mailing Address - Country:US
Mailing Address - Phone:972-755-9886
Mailing Address - Fax:
Practice Address - Street 1:1900 E PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-6819
Practice Address - Country:US
Practice Address - Phone:682-558-8720
Practice Address - Fax:682-558-8724
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32929122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist