NPIMap

Organization Active NPI

Mary R Pham DDS Dental Corporation

  • Pediatric Dentistry
  • Lake Forest, CA
National Provider Identifier
1194491738
Registry record updated Aug 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
MARY R PHAM DDS DENTAL CORPORATION
Practice address
12751-21771 Lake Forest Lane Dr.
Suite 21
Lake Forest, CA 92630
Phone
(714) 528-8252
NPI assigned
Aug 23, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2021

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

Authorized official

Name
Dr. Mary Regina Pham, D.D.SNPI 1316188030
Title
Ceo/Pediatric Dentist
Phone
(714) 528-8252

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X Primary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X

Addresses

Primary practice location

12751-21771 Lake Forest Lane Dr.
Suite 21
Lake Forest, CA 92630

Mailing address

1041 E Yorba Linda Blvd Ste 206
Placentia, CA 92870-3763
Phone (714) 528-8252

Other names 1

  • Lollipop Pediatric Dentistry & Orthodontics Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629849600000",
    "number": "1194491738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1041 E YORBA LINDA BLVD STE 206",
            "city": "PLACENTIA",
            "state": "CA",
            "postal_code": "928703763",
            "telephone_number": "714-528-8252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12751-21771 LAKE FOREST LANE DR.",
            "address_2": "SUITE 21",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "92630",
            "telephone_number": "714-528-8252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY R PHAM DDS DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-23",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "REGINA",
        "authorized_official_title_or_position": "CEO/PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "714-528-8252",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lollipop Pediatric Dentistry & Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Forest, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 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.