# ODONTO PROSTHETICS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871897496
- **Authorized official:** PETER PHAN (OWNER)
- **Authorized official phone:** (503) 235-0774

## Contact information

- **Practice address:** 15 SE 22ND AVENUE, PORTLAND, OR 97214-1679
- **Practice address phone:** (503) 235-0774
- **Mailing address:** 15 SE 22ND AVENUE, PORTLAND, OR 97214-1679
- **Mailing address phone:** (503) 235-0774

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 292200000X | Dental Laboratory | 686917 | OR | Yes |

## Other

- **Enumeration date:** 12/23/2010
- **Last updated:** 12/23/2010