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General NPI Number Information
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NPI Number | 1659169167
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Entity Type | Organization
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Legal Business Name | KING & CROWN LLC
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Dates
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Enumeration Date | 04/26/2025
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Last Update Date | 04/26/2025
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Provider Practice Location Address
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Address Line | 4506 SE 105TH AVE
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City | PORTLAND
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State | OR
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Zip | 97266-3528
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Country | US
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Telephone | 503-512-0206
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Fax |
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Provider Business Mailing Address
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Address Line | 10253 SE NICOLE LOOP
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-6879
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Country | US
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Telephone | 503-512-0062
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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 | HIBERY NHU HO
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Credential | DMD
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Telephone | 971-717-1302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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