Dawna Phan & Mindy Phan a Professional Dental Corp.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D49392 Issued in CA

Legal business name

DAWNA PHAN & MINDY PHAN A PROFESSIONAL DENTAL CORP.

Practice address

12042 Brookhurst St
Garden Grove, CA 92840-2815

Phone

(714) 539-9500

NPI assigned

Dec 29, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Mindy T Phan, D.D.SNPI 1609905850

Title

Ceo

Phone

(714) 539-9500

Specialties & licenses 1

Addresses

Other names 1

• oc tooth fairy dental Doing business as

Locations

Practitioners 1

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

• Mindy Trieu Phan, D.M.D

  • General Practice Dentistry
  • Garden Grove, CA
  • NPI 1609905850
  NPD (past) Authorized official

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861558207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12042 BROOKHURST ST",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928402815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12042 BROOKHURST ST",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928402815",
            "telephone_number": "714-539-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAWNA PHAN & MINDY PHAN A PROFESSIONAL DENTAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "MINDY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "714-539-9500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "D49392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "oc tooth fairy dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael D'Anthony Davis
• Nicholas Davis
• Quinaea Diane Davis
• Teddie Davis
• Dawn M. Miller,O.D.
• Emily Day
• Dayle McIntosh Center for the Disabled
• Jennifer Rose De Castro
• Iny De Croos
• Candy Grace Jacome De Guzman

• General Practice Dentistry in Garden Grove, CA
• Providers in Garden Grove, 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 22, 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.