Provider Demographics
NPI:1144660358
Name:PHAN, THANH HOANG (DDS)
Entity type:Individual
Prefix:DR
First Name:THANH
Middle Name:HOANG
Last Name:PHAN
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 1:7950 S DROMEDARY DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1348
Mailing Address - Country:US
Mailing Address - Phone:714-467-8672
Mailing Address - Fax:
Practice Address - Street 1:14100 N 83RD AVE STE 280
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5660
Practice Address - Country:US
Practice Address - Phone:714-467-8672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ87661223D0004X
CA623181223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology