Organization
KOOLSMILES DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DERRICK PHAM DDS (PRESIDENT)
(714) 417-0246
Entity
Organization
Contact information
Practice address
1975 W CRAIG RD STE 103, NORTH LAS VEGAS, NV 89032-0332
(702) 220-4266
Mailing address
5947 AZZURA PALMS AVE, LAS VEGAS, NV 89139-6968
(714) 417-0246
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/06/2021
Last updated
06/06/2021
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