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Organization
PORT ORANGE MODERN DENTISTRY, PA
Active
Organization
PORT ORANGE MODERN DENTISTRY, PA
Active
Other names
Port Orange Modern Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MINH B PHAM DDS (OWNER/GP)
(386) 259-3905
Entity
Organization
Contact information
Practice address
1765 DUNLAWTON AVE., SUITE 103, PORT ORANGE, FL 32129
(386) 259-3905
(386) 259-3905
Mailing address
PO BOX 920050, DALLAS, TX 75392-0050
(714) 845-8890
(303) 952-0892
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
10/08/2018
Last updated
08/25/2022
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