Individual
NICKY PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
811 SW 19TH ST STE A, MOORE, OK 73160-2890
(405) 703-5161
Mailing address
400 RIVERWALK TER STE 250, JENKS, OK 74037-5619
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7750
OK
Other
Enumeration date
05/16/2023
Last updated
05/16/2023
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