Individual
MY HAI LAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1102 NE 82ND AVE, PORTLAND, OR 97220-5701
(503) 408-8927
Mailing address
8623 SE FLAVEL ST, PORTLAND, OR 97266-5760
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D11659
OR
Other
Enumeration date
07/08/2022
Last updated
07/25/2022
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