Healthcare Provider Details

I. General information

NPI: 1568534519
Provider Name (Legal Business Name): TRANG N PHAM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10356 NE WASCO ST
PORTLAND OR
97220
US

IV. Provider business mailing address

10356 NE WASCO ST
PORTLAND OR
97220
US

V. Phone/Fax

Practice location:
  • Phone: 503-252-2600
  • Fax: 503-252-4020
Mailing address:
  • Phone: 503-252-2600
  • Fax: 503-252-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD7173
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: