Provider Demographics
NPI:1992143713
Name:PHAM, CHAU M (DMD)
Entity type:Individual
Prefix:
First Name:CHAU
Middle Name:M
Last Name:PHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 E LA VIEVE LN
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3542
Mailing Address - Country:US
Mailing Address - Phone:480-216-2181
Mailing Address - Fax:
Practice Address - Street 1:2055 N ALMA SCHOOL RD STE 22
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2866
Practice Address - Country:US
Practice Address - Phone:480-273-8827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008726122300000X
CA62492122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist