Provider Demographics
NPI:1730619636
Name:PHAM, NANCY KIM (DDS)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:KIM
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 1:2626 RIDGEMEADE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-3276
Mailing Address - Country:US
Mailing Address - Phone:214-926-2064
Mailing Address - Fax:
Practice Address - Street 1:185 NW JOHN JONES DR STE 600
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8043
Practice Address - Country:US
Practice Address - Phone:817-295-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX329681223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice