Organization
THAI PHAM DMD PA
Active
Other names
Endodontic Innovations
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THAI VU PHAM DMD, PHD (DIRECTOR)
(813) 802-6849
Entity
Organization
Contact information
Practice address
13127 KINGS LAKE DR, SUITE 101, GIBSONTON, FL 33534-3958
(813) 284-7958
(813) 284-7959
Mailing address
13127 KINGS LAKE DR, SUITE 101, GIBSONTON, FL 33534-3958
(813) 284-7958
(813) 284-7959
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
DN18558
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017179500
—
FL
Enumeration date
09/06/2016
Last updated
08/26/2022
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