Organization
MARY R. PHAM, D.D.S., INC.
Active
Other names
Lollipop Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL PHAM PHARMD. (MANAGER)
(334) 657-7668
Entity
Organization
Contact information
Practice address
2750 HARBOR BLVD # B-06, COSTA MESA, CA 92626-5121
(334) 657-7668
Mailing address
2750 HARBOR BLVD # B-06, COSTA MESA, CA 92626-5121
(334) 657-7668
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
01/23/2019
Last updated
01/23/2019
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