Provider Demographics
NPI:1548668544
Name:PHUC PHAN TRINH D.D.S INC
Entity type:Organization
Organization Name:PHUC PHAN TRINH D.D.S INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHUC
Authorized Official - Middle Name:PHAN
Authorized Official - Last Name:TRINH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-678-0102
Mailing Address - Street 1:1608 MCKEE RD #20
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116
Mailing Address - Country:US
Mailing Address - Phone:408-678-0102
Mailing Address - Fax:408-678-0104
Practice Address - Street 1:1608 MCKEE RD #20
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116
Practice Address - Country:US
Practice Address - Phone:408-678-0102
Practice Address - Fax:408-678-0104
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHUC PHAN TRINH D.D.S INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-08
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46703122300000X
122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty