Provider Demographics
NPI:1548390701
Name:PHAM, TRINH (DDS)
Entity type:Individual
Prefix:DR
First Name:TRINH
Middle Name:
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 1:10431 LEMON AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-3700
Mailing Address - Country:US
Mailing Address - Phone:909-476-8303
Mailing Address - Fax:
Practice Address - Street 1:10431 LEMON AVE
Practice Address - Street 2:SUITE K
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91737-3700
Practice Address - Country:US
Practice Address - Phone:909-476-8303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA455171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice