Organization
MARY PHAM IKEDA DDS MS INC
Active
Other names
Lollipop Pediatric Dentistry & Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY REGINA PHAM DDS MS (CEO PEDIATRIC DENTISTY)
(714) 528-8252
Entity
Organization
Contact information
Practice address
4251 LONG BEACH BLVD UNIT C, LONG BEACH, CA 90807-2003
(714) 528-8252
Mailing address
2750 HARBOR BLVD STE B6, COSTA MESA, CA 92626-5121
(714) 528-8252
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
12/22/2020
Last updated
12/22/2020
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