Individual
JENNIFER PHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D, M.S
Contact information
Practice address
42550 STIRES DR, CHANTILLY, VA 20152-6655
(703) 629-5088
Mailing address
42550 STIRES DR, CHANTILLY, VA 20152-6655
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401412994
VA
Other
Enumeration date
02/25/2011
Last updated
02/25/2011
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