Mary Pham DDS Dental Corporation

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

MARY PHAM DDS DENTAL CORPORATION

Practice address

13931 Carroll Way Ste C
Tustin, CA 92780-1861

Phone

(714) 528-8252

NPI assigned

Dec 22, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Mary Regina Pham, DDS MS

Title

Ceo Pediatric Dentist

Phone

(714) 528-8252

Specialties & licenses 2

Addresses

Other names 1

• Lollipop Pediatric Dentistry & Orthodontics Doing business as

Locations

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

{
    "created_epoch": "1608595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643846400000",
    "number": "1245827377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 HARBOR BLVD STE B6",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926265121",
            "telephone_number": "714-528-8252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13931 CARROLL WAY STE C",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927801861",
            "telephone_number": "714-528-8252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY PHAM DDS DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-22",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "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": "DDS MS"
    },
    "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"
        },
        {
            "organization_name": "Lollipop Pediatric Dentistry & Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nylvia Martinez
• Prescilla Martinez
• Rafael Lopez Martinez
• Tracy Martino
• Mary M. Jew DDS, a Professional Organization
• Caroline Mason, PA-C
• Masoudaramdds.Inc
• Victoria Mata
• Briana Mateo
• Natalia Shannon Materazzo

• Pediatric Dentistry in Tustin, CA
• Providers in Tustin, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; 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.