Derrick Pham DDS Professional Corporation Dba LV Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DERRICK PHAM DDS PROFESSIONAL CORPORATION DBA LV DENTAL

Practice address

4705 S Durango Dr Ste 115
Las Vegas, NV 89147-8162

Phone

(714) 417-0246

NPI assigned

Jul 28, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Derrick Pham, DDSNPI 1588011373

Title

President

Phone

(714) 417-0246

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Derrick Tuan Pham, D.D.S

  • General Practice Dentistry
  • Huntington Beach, CA
  • NPI 1588011373
  NPD Authorized official

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

{
    "created_epoch": "1658966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658966400000",
    "number": "1811623283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4705 S DURANGO DR STE 115",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891478162",
            "telephone_number": "714-417-0246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705 S DURANGO DR STE 115",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891478162",
            "telephone_number": "714-417-0246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERRICK PHAM DDS PROFESSIONAL CORPORATION DBA LV DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-28",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-417-0246",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kim Margaret Derocher Larsen, RRT
• Taylor Marilyn Derose, DPT
• Rose Ann Derouen
• Emily Marie Derrera, DPT
• Derrick Copes
• Merian Razon Derrick
• Samantha Derrick
• Timica Lynn Derrick
• William Derrick Jr.
• Aimee Michelle Derrico

• General Practice Dentistry in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• General Practice Dentistry in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.