Tlc Dentistry

NPI #1356604516 in Portland, Oregon

Provider Information

NPI Number: 1356604516
Entity Type: Organization
Organization Name: Tlc Dentistry
Subpart: Yes (part of a larger organization)
Parent Organization: TLC DENTISTRY
Primary Specialty: Dentist
Enumeration Date: Jun 21, 2012
Last Updated: Jun 21, 2012

Practice Location

Address: 6919 S.E. 82ND AVE. STE 103
City: Portland
State: Oregon
ZIP Code: 97266
Phone: (503) 774-3546

Authorized Official

Name: DR. ANDREW KYANH PHAN, D.M.D.
Title: DOCTOR OF DENTAL MEDICINE. OWNER.
Phone: (503) 774-3546

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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