Diep Pham DDS, INC
Dentist, General Practice in Lake Jackson, TX. Organization (NPI-2).
NPI number1770840340
StatusActive
Last updated in NPPESApr 19, 2012
Details
- NPI
- 1770840340
- Entity type
- Organization (NPI-2)
- Legal business name
- Diep Pham DDS, INC
- Organization subpart
- Yes
- Enumeration date
- Apr 19, 2012
- Last updated
- Apr 19, 2012
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 17862 | TX | Yes |
Other names
- Gulf Coast Dental (Doing Business As)
Practice location
309 Garland DrLake Jackson, TX 77566-6238
Phone 979-480-9300
Mailing address
Po Box 2086Alief, TX 77411-2086
Authorized official
Diep Pham
President
2812082016
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