TLC Dentistry

Primary specialty

DentistTaxonomy code 122300000X

License

D6465 Issued in OR

Legal business name

TLC DENTISTRY

Practice address

6919 S.E. 82ND Ave. Ste 103
Portland, OR 97266

Phone

(503) 774-3546

Fax

(503) 774-3547

NPI assigned

Jun 21, 2012

Organization subpart

Yes

Parent organization

TLC DENTISTRYAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Andrew Kyanh Phan, D.M.D.NPI 1467604454

Title

Doctor of Dental Medicine. Owner.

Phone

(503) 774-3546

Specialties & licenses 1

Addresses

Part of

TLC Dentistry

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrew Kyanh Phan, D.M.D.

  • General Practice Dentistry
  • Portland, OR
  • NPI 1467604454
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340236800000",
    "number": "1356604516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6919 S.E. 82ND AVE. SUITE 103",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97266",
            "telephone_number": "503-774-3546",
            "fax_number": "503-774-3547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6919 S.E. 82ND AVE. STE 103",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97266",
            "telephone_number": "503-774-3546",
            "fax_number": "503-774-3547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TLC DENTISTRY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TLC DENTISTRY",
        "enumeration_date": "2012-06-21",
        "last_updated": "2012-06-21",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "KYANH",
        "authorized_official_title_or_position": "DOCTOR OF DENTAL MEDICINE. OWNER.",
        "authorized_official_telephone_number": "503-774-3546",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OR",
            "license": "D6465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nishant Tiwari, M.D.
• Zachary Spencer Tjernlund
• Rita Crouse Tjoelker, RN, CNS
• Ninel Tkachman
• Sofya Tkachman, MD
• TLT Enterprises LLC
• Paul Stanley Tlucek, MD
• TM Glover Counseling, LLC
• TMJ and Dental Sleep Medicine
• TMS Physician Services, P.C.

• Dentist in Portland, OR
• Providers in Portland, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.