THAI PHAM DMD PA NPI 1174070361

NPI Information

  • NPI: 1174070361
  • Provider Name: THAI PHAM DMD PA
  • Classification: Dentist - 1223E0200X
  • Specialization: Endodontics
  • Entity Type: Organization
  • Doing Business As: ENDODONTIC INNOVATIONS
  • Address: 13127 KINGS LAKE DR
    SUITE 101
    GIBSONTON, FL
    ZIP 33534
  • Phone: (813) 284-7958

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NPI Details

THAI PHAM DMD PA is an endodontics dentist in Gibsonton, FL. The provider is the branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. THAI PHAM DMD PA NPI is 1174070361. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Endodontic Innovations.

The provider's business location address is:

13127 KINGS LAKE DR
SUITE 101
GIBSONTON, FL
ZIP 33534-958
Phone: (813) 284-7958
Fax: (813) 284-7959

The provider's authorized official is Thai Vu Pham .
The authorized official title is Director and has the following contact phone number (813) 802-6849.

The enumeration date for this NPI number is 9/6/2016 and was last updated on 8/26/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223E0200XDentistEndodonticsDN18558FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1017179500MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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