Provider Demographics
NPI:1144741083
Name:NGUYEN, LILLIAN PHAM (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:PHAM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 OSWEGO SMT
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1075
Mailing Address - Country:US
Mailing Address - Phone:503-740-5709
Mailing Address - Fax:
Practice Address - Street 1:9900 SW GREENBURG RD STE 230
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5473
Practice Address - Country:US
Practice Address - Phone:503-620-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD112841223P0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223P0300XDental ProvidersDentistPeriodontics