Active NPI
Huong Thu Phan, DMD
- Pediatric Dentistry
- Columbus, OH
National Provider Identifier
1073174637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DN25552
- Practice address
- 2300 W Broad St
Columbus, OH 43204-3783 - Phone
- (614) 645-2300
- Fax
- (614) 645-5517
- NPI assigned
- Jun 25, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | APP-000261372 | OH | |
| Pediatric Dentistry | 1223P0221X | DN25552 | FL | Primary |
Addresses
Primary practice location
2300 W Broad St
Columbus, OH 43204-3783
Mailing address
4419 Fallbrook Blvd
Palm Harbor, FL 34685-2653
Phone (813) 420-7005
Other practice location 1
700 Childrens Dr
Columbus, OH 43205-2664
Phone (614) 214-3341
Other practice location 2
4419 Fallbrook Blvd
Palm Harbor, FL 34685
Phone (813) 420-7005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APP-000261372 | OH | MD | Dentist |
| DN25552 | FL | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756080000000",
"number": "1073174637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4419 FALLBROOK BLVD",
"city": "PALM HARBOR",
"state": "FL",
"postal_code": "346852653",
"telephone_number": "813-420-7005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 W BROAD ST",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432043783",
"telephone_number": "614-645-2300",
"fax_number": "614-645-5517"
}
],
"practiceLocations": [
{
"address_1": "700 Childrens Dr",
"address_purpose": "LOCATION",
"city": "Columbus",
"state": "OH",
"postal_code": "432052664",
"country_code": "US",
"telephone_number": "614-214-3341",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4419 Fallbrook Blvd",
"address_purpose": "LOCATION",
"city": "Palm Harbor",
"state": "FL",
"postal_code": "34685",
"country_code": "US",
"telephone_number": "813-420-7005",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PHAN",
"first_name": "HUONG",
"middle_name": "THU",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-06-25",
"last_updated": "2025-08-25",
"certification_date": "2025-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "APP-000261372",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "FL",
"license": "DN25552",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.