The T. Phan, DDS, MD Professional Corp

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

55427 Issued in CA

Legal business name

THE T. PHAN, DDS, MD PROFESSIONAL CORP

Doing business as

Newbury Dental Studio

Practice address

1620 Newbury Rd Ste 5
Newbury Park, CA 91320-3401

Phone

(805) 600-4540

Fax

(805) 456-0768

NPI assigned

Feb 17, 2016

Last updated

Feb 17, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Brittany Wharton

Title

Office Manager

Phone

(805) 600-4540

Specialties & licenses 1

Addresses

Other names 1

• Newbury Dental Studio Doing business as

Locations

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

{
    "created_epoch": "1455667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455667200000",
    "number": "1548629694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 NEWBURY RD STE 5",
            "city": "NEWBURY PARK",
            "state": "CA",
            "postal_code": "913203401",
            "telephone_number": "805-600-4540",
            "fax_number": "805-456-0768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 NEWBURY RD STE 5",
            "city": "NEWBURY PARK",
            "state": "CA",
            "postal_code": "913203401",
            "telephone_number": "805-600-4540",
            "fax_number": "805-456-0768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE T. PHAN, DDS, MD PROFESSIONAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-17",
        "last_updated": "2016-02-17",
        "status": "A",
        "authorized_official_last_name": "WHARTON",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "805-600-4540",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "55427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Newbury Dental Studio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Newbury Park, CA
• Providers in Newbury Park, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2016; 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.