Provider Demographics
NPI:1760157929
Name:HO, NHU THI KHANH (DMD)
Entity type:Individual
Prefix:
First Name:NHU
Middle Name:THI KHANH
Last Name:HO
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:HIBERY
Other - Middle Name:
Other - Last Name:HO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:10253 SE NICOLE LOOP
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-6879
Mailing Address - Country:US
Mailing Address - Phone:971-717-1302
Mailing Address - Fax:
Practice Address - Street 1:4506 SE 105TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-3528
Practice Address - Country:US
Practice Address - Phone:503-250-2550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61195226122300000X
ORD11489122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist