Individual
DR. THIEN QUANG PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
12904 CENTRAL AVE NE, BLAINE, MN 55434-4147
(651) 621-4515
Mailing address
12904 CENTRAL AVE NE, BLAINE, MN 55434-4147
(651) 621-4515
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D13682
MN
Other
Enumeration date
05/19/2016
Last updated
05/19/2016
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