Provider Demographics
NPI:1750951505
Name:PHAM, NIKOLE MY-HUYEN (DMD)
Entity type:Individual
Prefix:DR
First Name:NIKOLE
Middle Name:MY-HUYEN
Last Name:PHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 MAJESTIC WAY
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-2144
Mailing Address - Country:US
Mailing Address - Phone:251-458-1771
Mailing Address - Fax:
Practice Address - Street 1:1654 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:92277
Practice Address - Country:US
Practice Address - Phone:251-458-1771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-0006918-C1122300000X, 1223S0112X
AL10042171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No171000000XOther Service ProvidersMilitary Health Care Provider