Individual
MIN-U TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4855 SW WESTERN AVE, BEAVERTON, OR 97005-3499
(503) 813-2000
Mailing address
14820 NE 74TH CIR, VANCOUVER, WA 98682-5097
(360) 281-5388
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
DN61216096
WA
122400000X
Denturist
Primary
DT-DO-10222225
OR
126900000X
Dental Laboratory Technician
—
—
Other
Enumeration date
02/28/2023
Last updated
02/28/2023
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