Provider Demographics
NPI:1699203513
Name:CAITLIN C. HAN, DMD, LLC
Entity Type:Organization
Organization Name:CAITLIN C. HAN, DMD, LLC
Other - Org Name:TRYON CREEK FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:CHANH
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-636-2300
Mailing Address - Street 1:601 1ST ST STE E
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-2370
Mailing Address - Country:US
Mailing Address - Phone:503-636-2300
Mailing Address - Fax:
Practice Address - Street 1:601 1ST ST STE E
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-2370
Practice Address - Country:US
Practice Address - Phone:503-636-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8962261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental