Provider Demographics
NPI:1174592323
Name:PHEN, ALFRED (DDS)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:
Last Name:PHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 LEISHA LN
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-6203
Mailing Address - Country:US
Mailing Address - Phone:916-708-6245
Mailing Address - Fax:
Practice Address - Street 1:1667 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0251
Practice Address - Country:US
Practice Address - Phone:530-223-5500
Practice Address - Fax:530-223-1790
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46929122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist