Provider Demographics
NPI:1386902757
Name:EMERGENCY TOOTH DOCTOR DOWNTOWN,P.C.
Entity type:Organization
Organization Name:EMERGENCY TOOTH DOCTOR DOWNTOWN,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-641-2200
Mailing Address - Street 1:1505 SW BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-3414
Mailing Address - Country:US
Mailing Address - Phone:503-222-0090
Mailing Address - Fax:503-222-0101
Practice Address - Street 1:1505 SW BROADWAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-3414
Practice Address - Country:US
Practice Address - Phone:503-222-0090
Practice Address - Fax:503-222-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD83001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty