Individual
KYLE H. VAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
16755 SW BASELINE RD, BEAVERTON, OR 97006-4241
(503) 533-4001
(503) 533-4116
Mailing address
420 NW 11TH AVE, PORTLAND, OR 97209-2972
(503) 702-3565
(503) 533-4116
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7871
OR
Other
Enumeration date
09/30/2005
Last updated
07/08/2007
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