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10211 Sw Park Way Portland OR 97225-5009 | |
| (503) 233-3622 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 10211 Sw Park Way, Portland, Oregon |
| Authorized Official Name and Position | Bao V Pham (OWNER) |
| Authorized Official Contact | 5032333622 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
10211 Sw Park Way Portland OR 97225-5009 Ph: () - | 10211 Sw Park Way Portland OR 97225-5009 Ph: (503) 233-3622 |
| NPI Number | 1063921823 |
|---|---|
| Provider Enumeration Date | 09/25/2017 |
| Last Update Date | 09/25/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063921823 | NPI | - | NPPES |
| 1780706226 | Other | OR | NPI FOR DENTIST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D8162 (Oregon) | Primary |
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