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Organization
DIEP PHAM PC
Active
Organization
DIEP PHAM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIEP PHAM (GENERAL DENTIST)
(503) 888-6077
Entity
Organization
Contact information
Practice address
13510 NE 84TH ST STE 105, VANCOUVER, WA 98682
(360) 726-6966
Mailing address
5210 SE 112TH AVE, PORTLAND, OR 97266-4182
(503) 888-6077
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D9395
OR
Other
Enumeration date
09/04/2018
Last updated
09/05/2018
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