Nhung Thi Phan, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

4270 Issued in SC

Practice address

1365 Broadcloth St Ste 204
Fort Mill, SC 29715-4507

Phone

(803) 548-8858

Fax

(803) 548-8860

NPI assigned

Nov 29, 2006

Sex

Female

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 SC

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

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

• Lotus Dental Associates LLC

  • Dental Clinic/Center
  • Fort Mill, SC
  • NPI 1730740887
  NPD (past) Authorized official

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558656000000",
    "number": "1821165507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1365 BROADCLOTH ST STE 204",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297154507",
            "telephone_number": "803-548-8858",
            "fax_number": "803-548-8860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1365 BROADCLOTH ST STE 204",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297154507",
            "telephone_number": "803-548-8858",
            "fax_number": "803-548-8860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "NHUNG",
        "middle_name": "THI",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2019-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "4270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peoples Medical Supply Inc
• Jason H. Perey, MD
• Shawnie Renee Perkins, MSPAS, PA-C
• Kelly A Perron, MS, LPC, LCMHC, AADC
• Peterkin & Associates, LLC.
• Trudy Phelps, PH.D
• Phoenix Wellness LLC
• Piedmont Express Care at Sutton Road, LLC
• Piedmont Express Care at Sutton Road, LLC
• Piedmont Family Practice at Baxter Village, LLC

• Dentist in Fort Mill, SC
• Providers in Fort Mill, SC by specialty
• Dentist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 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.