Provider Demographics
NPI:1023467925
Name:PHAM, QUYEN T (DMD)
Entity type:Individual
Prefix:
First Name:QUYEN
Middle Name:T
Last Name:PHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 STIRLING CENTER PL STE 1701
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5712
Mailing Address - Country:US
Mailing Address - Phone:352-404-5550
Mailing Address - Fax:
Practice Address - Street 1:743 STIRLING CENTER PL STE 1701
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5712
Practice Address - Country:US
Practice Address - Phone:352-404-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN218651223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics