Thach Pham, D.M.D

Primary specialty

DentistTaxonomy code 122300000X

License

DN16419 Issued in FL

Practice address

1417 Lakeland Hills Blvd Ste 101
Lakeland, FL 33805-3200

Phone

(866) 234-8534

NPI assigned

Mar 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Networks

• Freedom Health HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Central Florida Health Care, Inc.

  dba Central Florida Health Care Frostproof

  • Federally Qualified Health Center (FQHC)
  • Frostproof, FL
  • NPI 1467449660
  Medicare reassignment NPD
• Affordable Dentures - Lakeland, P.a.

  • Dentist
  • Lakeland, FL
  • NPI 1174827901
  NPD (past) Authorized official
• Central Florida Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Bartow, FL
  • NPI 1811796469
  NPD
• Central Florida Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Avon Park, FL
  • NPI 1831232669
  NPD
• Affordable Dentures & Implants - Lakeland, P.a.

  • General Practice Dentistry
  • Lakeland, FL
  • NPI 1073320487
  NPD (past)

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641340800000",
    "number": "1407816903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 5TH ST NW",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338814672",
            "telephone_number": "866-234-8534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 LAKELAND HILLS BLVD STE 101",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338053200",
            "telephone_number": "866-234-8534"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "950 County Road 17A W",
            "address_purpose": "LOCATION",
            "city": "Avon Park",
            "state": "FL",
            "postal_code": "338252164",
            "country_code": "US",
            "telephone_number": "866-234-8534",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAM",
        "first_name": "THACH",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-27",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN16419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Pettitt
• Chandler Pewitt, RBT
• Richard T Pfaff, DC
• Baylin Pfluke, ARNP
• Khanh Thu Pham, MD
• Thuy Linh Pham, APRN
• Tri Minh Pham, MD
• Phung Dinh Phan, D.O.
• Philadelphia Professionals Inc
• Rengit Philip, MD

• Dentist in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.