Organization
PARKROSE FAMILY DENTISTRY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS THANH TIEU II DMD (OWNER)
(503) 254-5575
Entity
Organization
Contact information
Practice address
3620 NE 122ND AVE, PORTLAND, OR 97230-1365
(503) 254-5575
(503) 254-2162
Mailing address
3620 NE 122ND AVE, PORTLAND, OR 97230-1365
(503) 254-5575
(503) 254-2162
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D7324
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D7324
STATE LICENSE NUMBER
OR
Enumeration date
10/31/2006
Last updated
08/22/2020
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