Edward Peer Pham, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D11678 Issued in OR

Practice address

3075 SE Century Blvd Ste 109
Hillsboro, OR 97123-8187

Phone

(503) 642-1535

NPI assigned

Apr 5, 2022

Last updated

Oct 31, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Oregon Outpatient Anesthesia Associates LLC

  • Anesthesiology Physician
  • Portland, OR
  • NPI 1083499727
  NPD (past)

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1518608603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3075 SE CENTURY BLVD STE 109",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971238187",
            "telephone_number": "503-642-1535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3075 SE CENTURY BLVD STE 109",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971238187",
            "telephone_number": "503-642-1535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "EDWARD",
        "middle_name": "PEER",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-05",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OR",
            "license": "D11678",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heidi Petrowsky, RD
• Tiffany Petterborg, PA-C
• Haile Peveto
• Kalena Pfaeltzer
• Garth Paul Pfeifer
• Hai Thanh Pham, DMD
• Kaylia Pham
• Mai Pham, DPT
• Robyn Pham
• Thi Pham, RDH

• Pediatric Dentistry in Hillsboro, OR
• Providers in Hillsboro, OR by specialty
• Pediatric Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.