Provider Demographics
NPI:1336419787
Name:BEAVERTON PERIODONTICS
Entity Type:Organization
Organization Name:BEAVERTON PERIODONTICS
Other - Org Name:DUY ANH TRAN, DMD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUY ANH
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-747-0095
Mailing Address - Street 1:14500 SW MURRAY SCHOLLS DR
Mailing Address - Street 2:SUITE #101
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-9277
Mailing Address - Country:US
Mailing Address - Phone:503-747-0095
Mailing Address - Fax:
Practice Address - Street 1:14500 SW MURRAY SCHOLLS DR
Practice Address - Street 2:SUITE #101
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-9277
Practice Address - Country:US
Practice Address - Phone:503-747-0095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD73601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty