Individual
DR. H. DERICK PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., C.A.G.S.
Contact information
Practice address
11040 BOLLINGER CANYON RD, SUITE K, SAN RAMON, CA 94582-4959
(925) 648-8588
(925) 648-8008
Mailing address
11040 BOLLINGER CANYON RD, SUITE K, SAN RAMON, CA 94582-4959
(925) 648-8588
(925) 648-8008
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
49186
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
D6446
AZ
Other
Enumeration date
07/16/2007
Last updated
07/29/2008
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