Organization
WILLAMETTE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOAN THANH PHAN (DENTAL HYGIENE)
(971) 222-8003
Entity
Organization
Contact information
Practice address
4925 SW GRIFFITH DR, BEAVERTON, OR 97005
(971) 222-8003
Mailing address
16213 SW BRAY LN, TIGARD, OR 97224
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
H5284
OR
Other
Enumeration date
11/21/2013
Last updated
11/21/2013
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