Individual
DR. BENNIE VAN PHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
18426 BROOKHURST ST STE 101, FOUNTAIN VALLEY, CA 92708-6777
(714) 965-5255
Mailing address
8981 ACACIA AVE, GARDEN GROVE, CA 92841-4613
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
054267
NY
122300000X
Dentist
Primary
58021
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054267
NY STATE DENTAL LICENSE
NY
01
—
58021
CA STATE DENTAL LICENSE
CA
Enumeration date
12/26/2008
Last updated
12/11/2019
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