Provider Demographics
NPI:1538528831
Name:OAKLAND PARK MODERN DENTISTRY PA
Entity type:Organization
Organization Name:OAKLAND PARK MODERN DENTISTRY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MINH
Authorized Official - Middle Name:B
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-261-5665
Mailing Address - Street 1:1005 E COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3956
Mailing Address - Country:US
Mailing Address - Phone:954-261-5665
Mailing Address - Fax:954-776-6001
Practice Address - Street 1:17000 RED HILL AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-5626
Practice Address - Country:US
Practice Address - Phone:714-845-8890
Practice Address - Fax:949-474-1495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty