Organization
GLISAN DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAN BA PHAM DMD (DENTIST)
(503) 208-2220
Entity
Organization
Contact information
Practice address
7990 NE GLISAN ST, PORTLAND, OR 97213-7040
(503) 208-2220
Mailing address
7990 NE GLISAN ST, PORTLAND, OR 97213-7040
(503) 208-2220
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/03/2009
Last updated
08/03/2009
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