Provider Demographics
NPI:1457749632
Name:VAN A. HAN DMD LLC
Entity Type:Organization
Organization Name:VAN A. HAN DMD LLC
Other - Org Name:RADIANT FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VAN
Authorized Official - Middle Name:AI
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-866-6242
Mailing Address - Street 1:11000 SE LENORE ST
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-8790
Mailing Address - Country:US
Mailing Address - Phone:503-866-6242
Mailing Address - Fax:
Practice Address - Street 1:601 CENTER ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2253
Practice Address - Country:US
Practice Address - Phone:503-656-1905
Practice Address - Fax:503-656-9680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD89591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty