Long P Pham, DDS
Individual provider Active NPI Dentist · Rock Falls, IL
NPI 1083840441 · NPPES record last updated Feb 6, 2012
Key facts
- NPI
- 1083840441
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019027905 (IL)
- Practice address
- 1300 W 2ND St
Rock Falls, IL 61071-1005 - Phone
- (815) 626-2230
- Fax
- (815) 626-6339
- NPI assigned
- May 29, 2009
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Networks
- Freedom Health HMO Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019027905 | IL | Yes |
Addresses
Primary practice location
1300 W 2ND St
Rock Falls, IL 61071-1005
Mailing address
1300 W 2ND St
Rock Falls, IL 61071-1005
Phone (815) 626-2230
Other providers in Rock Falls, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.