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General NPI Number Information
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NPI Number | 1598396186
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Entity Type | Organization
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Legal Business Name | EMERGENCY TOOTH DOCTOR CAMAS, P.C.
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Dates
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Enumeration Date | 01/31/2020
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Last Update Date | 01/31/2020
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Provider Practice Location Address
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Address Line | 217 SE 136TH AVE STE 102
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City | VANCOUVER
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State | WA
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Zip | 98684-6908
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Country | US
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Telephone | 360-896-9595
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Fax |
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Provider Business Mailing Address
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Address Line | 14665 SW MILLIKAN WAY
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City | BEAVERTON
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State | OR
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Zip | 97003-2999
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Country | US
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Telephone | 503-641-2200
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Fax | 503-641-2223
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS T PHAM
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Credential | DMD
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Telephone | 971-226-6233
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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 |
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License Number State |
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