Provider Demographics
NPI:1679788822
Name:EMERGENCY TOOTH DOCTOR, P.C.
Entity type:Organization
Organization Name:EMERGENCY TOOTH DOCTOR, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
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 1:13779 SW FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2603
Mailing Address - Country:US
Mailing Address - Phone:503-641-2200
Mailing Address - Fax:503-641-2220
Practice Address - Street 1:13779 SW FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2603
Practice Address - Country:US
Practice Address - Phone:503-641-2200
Practice Address - Fax:503-641-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty