Individual
THAO KIM PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
4201 CENTRAL AVE NW STE F1, ALBUQUERQUE, NM 87105-1669
(505) 843-7172
Mailing address
6705 VISTA DEL RANCHO RD NE, ALBUQUERQUE, NM 87113-1785
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD5269
NM
Other
Enumeration date
06/09/2020
Last updated
06/09/2020
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