NPI 1356771786

Willamette Dental

Organisation Preferred Provider Organization Beaverton, OR

Practice location

Address: 4925 SW Griffith Dr, Beaverton, OR 97005
Phone: (971) 222-8003
Mailing address: 16213 SW Bray Ln, Tigard, OR 97224

Authorised official

Name: Loan Thanh Phan
Title: Dental Hygiene
Phone: (971) 222-8003

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence H5284 (OR)

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Registry record

NPI: 1356771786
Entity type: Organization
NPI issued: 21 Nov 2013
Record last updated: 21 Nov 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.