Organization
ODONTO PROSTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER PHAN (OWNER)
(503) 235-0774
Entity
Organization
Contact information
Practice address
15 SE 22ND AVENUE, PORTLAND, OR 97214-1679
(503) 235-0774
Mailing address
15 SE 22ND AVENUE, PORTLAND, OR 97214-1679
(503) 235-0774
Taxonomy
Speciality
Code
Description
License number
State
292200000X
Dental Laboratory
Primary
686917
OR
Other
Enumeration date
12/23/2010
Last updated
12/23/2010
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