Provider Demographics
NPI:1861878951
Name:PHAM, THO THI-XUAN (DDS)
Entity type:Individual
Prefix:DR
First Name:THO
Middle Name:THI-XUAN
Last Name:PHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:THO
Other - Middle Name:THI-XUAN
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:10901 GARLAND RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-2613
Mailing Address - Country:US
Mailing Address - Phone:214-321-8400
Mailing Address - Fax:
Practice Address - Street 1:4431 W WALNUT ST
Practice Address - Street 2:UNIT A
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-4107
Practice Address - Country:US
Practice Address - Phone:972-485-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31323122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist