Individual
DAVID PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
10747 COLLETT AVE, RIVERSIDE, CA 92505-2923
(951) 324-3156
Mailing address
10747 COLLETT AVE, RIVERSIDE, CA 92505-2923
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2014011361
MO
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
63122
CA
Other
Enumeration date
06/19/2012
Last updated
07/22/2021
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