Emily Pham, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN23400 Issued in FL

Practice address

1505 Delaware Ave
Fort Pierce, FL 34950-3975

Phone

(772) 461-1402

Fax

(844) 540-4794

NPI assigned

Aug 18, 2019

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Emilyphamdental PLLC

  • Dental Clinic/Center
  • Port St Lucie, FL
  • NPI 1578412953
  NPD Authorized official

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

{
    "created_epoch": "1566086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580169600000",
    "number": "1851947568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5827 CORPORATE WAY",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334072000",
            "telephone_number": "561-844-9443",
            "fax_number": "561-844-1013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 DELAWARE AVE",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349503975",
            "telephone_number": "772-461-1402",
            "fax_number": "844-540-4794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "EMILY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-18",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN23400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shabronah Pettiford
• Stacy Pettiford
• Gary Courtland Pettit, BA
• Frank Joseph Pezzimenti, PA-C
• Barbara Kim Pfister, RRT
• Pharmacist Consultant Services, LLC
• Ida Marlene Pharr, L.C.S.W.
• Tatyana Philipp
• Corliss Y Phillips, LPN
• Helene P Phillips

• General Practice Dentistry in Fort Pierce, FL
• Providers in Fort Pierce, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; 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.