Anthony Pham

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DDS104207 Issued in CA

Practice address

4360-C E Main St
Ventura, CA 93003-2331

Phone

(805) 426-4739

NPI assigned

Mar 17, 2018

Sex

Male

Sole proprietor

Yes

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 CA

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

State licenses

Practice roles

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.

• Santa Barbara Neighborhood Clinics

  dba Eastside Neighborhood Clinic

  • Federally Qualified Health Center (FQHC)
  • Santa Barbara, CA
  • NPI 1063438232
  NPD (past)
• Santa Barbara Neighborhood Clinics

  dba Eastside Family Dental Clinic

  • Dental Clinic/Center
  • Santa Barbara, CA
  • NPI 1972636835
  NPD (past)

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

{
    "created_epoch": "1521244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566691200000",
    "number": "1659874436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4360-C E MAIN ST",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930038279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4360-C E MAIN ST",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930032331",
            "telephone_number": "805-426-4739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "ANTHONY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-17",
        "last_updated": "2019-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS104207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Bethany Petrisin, MSED, ATC, NCMT
• Jeffrey J. Petron, D.D.S.
• Petros K. Frousiakis, D.O., a Professional Corporation
• Nila Chari Petrowski, P.T.
• Laszlo Petruska, D.D.S.
• Keila May Pham
• Victoria Pham, RN
• Stephanie Phan
• Pharmerica Drug Systems LLC (Pharmerica)
• Jayne Alison Phelan, FNP

• General Practice Dentistry in Ventura, CA
• Providers in Ventura, 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 Aug 25, 2019; 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.