Organization
MARY R PHAM DDS DENTAL CORPORATION
Active
Other names
Lollipop Pediatric Dentistry & Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY REGINA PHAM D.D.S (CEO/PEDIATRIC DENTIST)
(714) 528-8252
Entity
Organization
Contact information
Practice address
12751-21771 LAKE FOREST LANE DR., SUITE 21, LAKE FOREST, CA 92630
(714) 528-8252
Mailing address
1041 E YORBA LINDA BLVD STE 206, PLACENTIA, CA 92870-3763
(714) 528-8252
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
08/23/2021
Last updated
08/25/2021
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