| NPI | 1861525818 |
|---|---|
| Former Name | GINA CUC PHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401411775) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 13454) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: DC DEN1001433) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2021-03-17 |