Individual
DR. AUSTIN PHOENIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D., M.S.D.
Contact information
Practice address
443 NW BURNSIDE RD, GRESHAM, OR 97030-3714
(503) 492-8487
Mailing address
443 NW BURNSIDE RD, GRESHAM, OR 97030-3714
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D9012
OR
Other
Enumeration date
11/05/2007
Last updated
11/05/2007
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