| Organization Name: | AMY H. PHAM, A PROFESSIONAL DENTAL CORPORATION |
| NPI Number: | 1083005698 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AMY H PHAM (OWNER) |
| Mailing Address: | 2630 Olive Hwy Suite A Oroville |
| State: | CA US |
| Postal Code: | 959666138 |
| Phone Number: | 5305346666 |
| Fax Number: | 5305341040 |
| NPI Enumeration Date: | 02/18/2015 |
| NPI Last Update Date: | 02/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 52451 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |