Individual
DIEP NGOC PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
5210 SE 112TH AVE, PORTLAND, OR 97266-4182
(503) 760-1228
Mailing address
5210 SE 112TH AVE, PORTLAND, OR 97266-4182
(503) 760-1228
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D9395
OR
Other
Enumeration date
02/22/2010
Last updated
02/22/2010
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