Individual
LEVI QUANGLONG PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3625 NW 39TH ST, OKLAHOMA CITY, OK 73112-6309
(405) 253-0107
Mailing address
921 NE 13TH ST, OKLAHOMA CITY, OK 73104-5007
(405) 456-1000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7384
OK
Other
Enumeration date
07/08/2020
Last updated
09/07/2021
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