Provider Demographics
NPI:1447480488
Name:SEN, THANH PHAM (DDS)
Entity type:Individual
Prefix:DR
First Name:THANH
Middle Name:PHAM
Last Name:SEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:THANH
Other - Middle Name:LAN
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1090 CRANSTON ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-7323
Mailing Address - Country:US
Mailing Address - Phone:401-942-4867
Mailing Address - Fax:
Practice Address - Street 1:1090 CRANSTON ST
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-7323
Practice Address - Country:US
Practice Address - Phone:401-942-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN030591223G0001X
TX00249011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice