Provider Demographics
NPI:1154526325
Name:PHAM, HAI THANH (DMD)
Entity type:Individual
Prefix:DR
First Name:HAI
Middle Name:THANH
Last Name:PHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17149 SW WHITLEY WAY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003
Mailing Address - Country:US
Mailing Address - Phone:971-227-3312
Mailing Address - Fax:
Practice Address - Street 1:3075 SW 234TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-8187
Practice Address - Country:US
Practice Address - Phone:505-848-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD87751223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry