Individual
MELISSA PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
445 STATE ROAD 13, JACKSONVILLE, FL 32259-3838
(904) 209-6590
Mailing address
1357 MARSH GRASS CT, JACKSONVILLE, FL 32218-8646
(773) 742-4164
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
27900
FL
Other
Enumeration date
11/19/2020
Last updated
11/19/2020
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