MEDICARE: NHATHI THI HOANG DMD

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	D8285	OR

General Provider Information

NPI Number	:	1982783841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NHATHI THI HOANG DMD

Provider Business Mailing Address
First Line	:	16610 NW AVONDALE DR
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97006-7753
Country	:	US
Telephone Number	:	503-617-0981
Fax Number	:

Provider Business Practice Location Address
First Line	:	5329 NE M L KING BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-3237
Country	:	US
Telephone Number	:	503-988-3664
Fax Number	:	503-988-5700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/08/2007

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