Individual
DR. THOMAS THANH TIEU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3620 NE 122ND AVE, PORTLAND, OR 97230-1365
(503) 254-5575
(503) 254-2161
Mailing address
3620 NE 122ND AVE, PORTLAND, OR 97230-1365
(503) 254-5575
(503) 254-2161
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7324
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D7324
OREGON STATE LICENSE
OR
Enumeration date
10/26/2006
Last updated
07/08/2007
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