Individual
THANH PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
127 HIGH ST, CLINTON, MA 01510-2510
(617) 470-0902
(207) 853-6180
Mailing address
88 ANGELL ST, MANSFIELD, MA 02048-1449
(617) 470-0902
(207) 853-6180
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN1855283
MA
1223G0001X
General Practice Dentistry
Primary
DN1855283
MA
1223G0001X
General Practice Dentistry
PENDING
ME
Other
Enumeration date
06/15/2009
Last updated
04/28/2010
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