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3112 Lubbock Ave Ft Worth TX 76109-2324 | |
| (817) 769-3670 | |
| (817) 769-3677 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3112 Lubbock Ave, Ft Worth, Texas |
| Authorized Official Name and Position | Lynh Thy Pham (PRESIDENT) |
| Authorized Official Contact | 2147187880 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 450758 Garland TX 75045-0758 Ph: (214) 466-1400 | 3112 Lubbock Ave Ft Worth TX 76109-2324 Ph: (817) 769-3670 |
| NPI Number | 1275844383 |
|---|---|
| Provider Enumeration Date | 06/24/2010 |
| Last Update Date | 06/24/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275844383 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 19887 (Texas) | Primary |
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