Organization
ABC123 DENTAL IN HALTOM PLLC
Active
Other names
ABC123 Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRI H PHAM DDS (OWNER/DENTIST)
(817) 656-1215
Entity
Organization
Contact information
Practice address
5416 BASSWOOD BLVD, FORT WORTH, TX 76137-4400
(817) 656-1215
(877) 687-6861
Mailing address
5416 BASSWOOD BLVD, FORT WORTH, TX 76137-4400
(817) 656-1215
(877) 687-6861
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
24570
TX
Other
Enumeration date
08/16/2011
Last updated
08/16/2011
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