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General NPI Number Information
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NPI Number | 1699203513
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Entity Type | Organization
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Legal Business Name | CAITLIN C. HAN, DMD, LLC
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Dates
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Enumeration Date | 05/24/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 601 1ST ST STE E
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-2370
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Country | US
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Telephone | 503-636-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 601 1ST ST STE E
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-2370
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Country | US
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Telephone | 503-636-2300
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CAITLIN CHANH HAN
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Credential | DMD
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Telephone | 503-636-2300
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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 | D8962
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License Number State | OR
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