Provider Demographics
NPI:1477259216
Name:DOAN, PHUONG MAI THI (RDH)
Entity Type:Individual
Prefix:
First Name:PHUONG MAI
Middle Name:THI
Last Name:DOAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MAI
Other - Middle Name:THI
Other - Last Name:DOAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:11364 SE LOYAL CT
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-6298
Mailing Address - Country:US
Mailing Address - Phone:503-734-0640
Mailing Address - Fax:
Practice Address - Street 1:7105 SW HAMPTON ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8314
Practice Address - Country:US
Practice Address - Phone:800-813-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH7332124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH7332OtherOREGON BOARD OF DENTISTRY