| Chinook Falls Dental | |
|
36840 Industrial Way Sandy OR 97055-9254 | |
| (503) 668-8301 | |
| Not Available |
| Full Name | Chinook Falls Dental |
|---|---|
| Speciality | Dentist |
| Location | 36840 Industrial Way, Sandy, Oregon |
| Authorized Official Name and Position | Tin Minh Le (OWNER) |
| Authorized Official Contact | 5035444889 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chinook Falls Dental 36840 Industrial Way Sandy OR 97055-9254 Ph: (503) 668-8301 | Chinook Falls Dental 36840 Industrial Way Sandy OR 97055-9254 Ph: (503) 668-8301 |
| NPI Number | 1104360718 |
|---|---|
| Provider Enumeration Date | 12/16/2016 |
| Last Update Date | 12/16/2016 |
| Medicare PECOS PAC ID | 8022452838 |
|---|---|
| Medicare Enrollment ID | O20240220004492 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104360718 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D9841 (Oregon) | Primary |
| Provider Name | Tin Minh Le |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1922299445 PECOS PAC ID: 9931543741 Enrollment ID: I20240220004525 |
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