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General NPI Number Information
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NPI Number | 1598247884
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Entity Type | Organization
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Legal Business Name | DIEP PHAM PC
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Dates
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Enumeration Date | 09/04/2018
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Last Update Date | 09/05/2018
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Provider Practice Location Address
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Address Line | 13510 NE 84TH ST STE 105
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City | VANCOUVER
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State | WA
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Zip | 98682
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Country | US
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Telephone | 360-726-6966
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Fax |
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Provider Business Mailing Address
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Address Line | 5210 SE 112TH AVE
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City | PORTLAND
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State | OR
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Zip | 97266-4182
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Country | US
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Telephone | 503-888-6077
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DIEP PHAM
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Credential |
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Telephone | 503-888-6077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D9395
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License Number State | OR
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