Organization
NGO & PHAM DENTAL GROUP
Active
Other names
Grand Smile Care
Organization subpart
No
Provider details
NPI number
Authorized official
TUNG SON NGO DDS (OWNER)
(951) 549-0878
Entity
Organization
Contact information
Practice address
502 W GRAND BLVD, CORONA, CA 92882-2118
(951) 549-0878
(951) 496-4011
Mailing address
502 W GRAND BLVD, CORONA, CA 92882-2118
(951) 549-0878
(951) 496-4011
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689741159
—
CA
05
—
1831267053
—
CA
Enumeration date
03/30/2021
Last updated
03/30/2021
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