Provider Demographics
NPI:1144330499
Name:PHAM, HIEP DUY (DDS)
Entity type:Individual
Prefix:DR
First Name:HIEP
Middle Name:DUY
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 1:5103 BROADWAY ST STE 109
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-3959
Mailing Address - Country:US
Mailing Address - Phone:713-498-3417
Mailing Address - Fax:281-485-7745
Practice Address - Street 1:5103 BROADWAY ST STE 109
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-3959
Practice Address - Country:US
Practice Address - Phone:281-485-7767
Practice Address - Fax:281-485-7745
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111233601Medicaid