SD- 4315Frederick PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19887 Issued in TX

Legal business name

SD- 4315FREDERICK PC

Practice address

4522 Fredericksburg Rd
A28
San Antonio, TX 78201-6547

Phone

(210) 530-8841

Fax

(210) 530-8738

NPI assigned

Oct 21, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Lynhthy Thy Pham, DDSNPI 1548319627

Title

President

Phone

(214) 718-6052

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lynhthy T Pham, DDS

  • General Practice Dentistry
  • Garland, TX
  • NPI 1548319627
  NPD (past) Authorized official
• Tarig a Elmubarak Mohamed, DDS

  • General Practice Dentistry
  • San Antonio, TX
  • NPI 1154063469
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639699200000",
    "number": "1174074496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10901 GARLAND RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752182613",
            "telephone_number": "214-466-1400",
            "fax_number": "214-367-5896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4522 FREDERICKSBURG RD",
            "address_2": "A28",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782016547",
            "telephone_number": "210-530-8841",
            "fax_number": "210-530-8738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SD- 4315FREDERICK PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-21",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "LYNHTHY",
        "authorized_official_middle_name": "THY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-718-6052",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "19887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in San Antonio, TX
• Providers in San Antonio, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.