Provider Demographics
NPI:1306883285
Name:DOAN, PHUONG (DMD)
Entity type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:
Last Name:DOAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:DOAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:14201 NE 20TH AVE
Mailing Address - Street 2:SUITE 2204
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-6410
Mailing Address - Country:US
Mailing Address - Phone:360-571-8181
Mailing Address - Fax:360-573-4029
Practice Address - Street 1:13831 NW CORNELL RD
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5485
Practice Address - Country:US
Practice Address - Phone:503-614-9999
Practice Address - Fax:503-439-1299
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD74071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice