MEDICARE: PARKROSE FAMILY DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D7363	OR

General Provider Information

NPI Number	:	1225026123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKROSE FAMILY DENTAL

Provider Business Mailing Address
First Line	:	7346 NE SANDY BLVD
Second Line	:	SUITE A
City	:	PORTLAND
State	:	OR
Zip	:	97213-5758
Country	:	US
Telephone Number	:	503-287-7899
Fax Number	:	503-287-7933

Provider Business Practice Location Address
First Line	:	7346 NE SANDY BLVD
Second Line	:	SUITE A
City	:	PORTLAND
State	:	OR
Zip	:	97213-5758
Country	:	US
Telephone Number	:	503-287-7899
Fax Number	:	503-287-7933

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LAN TRAN
Credential	:	DMD
Telephone Number	:	503-287-7899

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	08/22/2020

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Directions to “PARKROSE FAMILY DENTAL ” Practice Location

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