Provider Demographics
NPI:1518608603
Name:PHAM, EDWARD PEER (DMD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:PEER
Last Name:PHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 SE CENTURY BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-8187
Mailing Address - Country:US
Mailing Address - Phone:503-642-1535
Mailing Address - Fax:
Practice Address - Street 1:3075 SE CENTURY BLVD STE 109
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-8187
Practice Address - Country:US
Practice Address - Phone:503-642-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORD116781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program