Glisan Dental Corporation

NPI #1316178734 in Portland, Oregon

Provider Information

NPI Number: 1316178734
Entity Type: Organization
Organization Name: Glisan Dental Corporation
Primary Specialty: Dentist - General Practice
Enumeration Date: Aug 3, 2009
Last Updated: Aug 3, 2009

Practice Location

Address: 7990 NE GLISAN ST
City: Portland
State: Oregon
ZIP Code: 97213-7040
Phone: (503) 208-2220

Authorized Official

Name: DR. TAN BA PHAM, DMD
Title: DENTIST
Phone: (503) 208-2220

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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