| Mary R Pham Dds Dental Corporation | |
|
12751-21771 Lake Forest Lane Dr. Suite 21 Lake Forest CA 92630 | |
| (714) 528-8252 | |
| Not Available |
| Full Name | Mary R Pham Dds Dental Corporation |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 12751-21771 Lake Forest Lane Dr., Lake Forest, California |
| Authorized Official Name and Position | Mary Regina Pham (CEO/PEDIATRIC DENTIST) |
| Authorized Official Contact | 7145288252 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary R Pham Dds Dental Corporation 1041 E Yorba Linda Blvd Ste 206 Placentia CA 92870-3763 Ph: (714) 528-8252 | Mary R Pham Dds Dental Corporation 12751-21771 Lake Forest Lane Dr. Suite 21 Lake Forest CA 92630 Ph: (714) 528-8252 |
| NPI Number | 1194491738 |
|---|---|
| Provider Enumeration Date | 08/23/2021 |
| Last Update Date | 08/25/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194491738 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Secondary |
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