Organization
B AND T LLC
Active
Other names
Laurelhurst Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
BAO V PHAM DMD (OWNER)
(503) 233-3622
Entity
Organization
Contact information
Practice address
10211 SW PARK WAY, PORTLAND, OR 97225-5009
(503) 233-3622
Mailing address
10211 SW PARK WAY, PORTLAND, OR 97225-5009
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D8162
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780706226
NPI FOR DENTIST
OR
Enumeration date
09/25/2017
Last updated
09/25/2017
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