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Organization
THAI PHAM DMD PA
Active
Organization
THAI PHAM DMD PA
Active
Other names
Endodontic Innovations
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THAI VU PHAM DMD, PHD (DIRECTOR)
(813) 802-6849
Entity
Organization
Contact information
Practice address
13127 KINGS LAKE DR, SUITE 101, GIBSONTON, FL 33534-3958
(813) 284-7958
(813) 284-7959
Mailing address
13127 KINGS LAKE DR, SUITE 101, GIBSONTON, FL 33534-3958
(813) 284-7958
(813) 284-7959
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
DN18558
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017179500
—
FL
Enumeration date
09/06/2016
Last updated
08/26/2022
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