Individual
LONG P PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1300 W 2ND ST, ROCK FALLS, IL 61071-1005
(815) 626-2230
(815) 626-6339
Mailing address
1300 W 2ND ST, ROCK FALLS, IL 61071-1005
(815) 626-2230
(815) 626-6339
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019027905
IL
Other
Enumeration date
05/29/2009
Last updated
02/06/2012
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