| NPI | 1104911940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOC B PHAM Dentist Secer Secretary 408-251-0118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 46515) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 46508) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-08-22 |