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General NPI Number Information
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NPI Number | 1841529823
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Entity Type | Organization
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Legal Business Name | PERLEDENT DENTAL CARE PC
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Dates
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Enumeration Date | 12/21/2009
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Last Update Date | 12/21/2009
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Provider Practice Location Address
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Address Line | 2110 NW AMBERBROOK DR
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City | HILLSBORO
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State | OR
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Zip | 97006-6954
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Country | US
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Telephone | 503-533-5539
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Fax | 503-533-5519
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Provider Business Mailing Address
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Address Line | 2110 NW AMBERBROOK DR
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City | HILLSBORO
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State | OR
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Zip | 97006-6954
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Country | US
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Telephone | 503-533-5539
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Fax | 503-533-5519
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KYLE HAI TRAN VAN
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Credential | DDS
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Telephone | 503-533-5539
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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 | D7871
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License Number State | OR
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