Provider Demographics
NPI:1609864396
Name:TERWILLIGER DENTAL PC
Entity Type:Organization
Organization Name:TERWILLIGER DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM LIEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-246-3034
Mailing Address - Street 1:7405 SW BARBUR BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2287
Mailing Address - Country:US
Mailing Address - Phone:503-246-3034
Mailing Address - Fax:503-246-3019
Practice Address - Street 1:7405 SW BARBUR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2287
Practice Address - Country:US
Practice Address - Phone:503-246-3034
Practice Address - Fax:503-246-3019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD67341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty