Provider Demographics
NPI:1487818647
Name:PHAM, TAM B (DDS)
Entity type:Individual
Prefix:DR
First Name:TAM
Middle Name:B
Last Name:PHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1347 LARPENTEUR AVE W
Mailing Address - Street 2:
Mailing Address - City:FALCON HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-699-5600
Mailing Address - Fax:651-699-1966
Practice Address - Street 1:1347 LARPENTEUR AVE W
Practice Address - Street 2:
Practice Address - City:FALCON HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55113
Practice Address - Country:US
Practice Address - Phone:651-699-5600
Practice Address - Fax:651-699-1966
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist