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1744 Ne 42nd Ave Portland OR 97213-1537 | |
| (503) 287-0072 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1744 Ne 42nd Ave, Portland, Oregon |
| Authorized Official Name and Position | Alexandra M Dahm (OWNER/DENTIST) |
| Authorized Official Contact | 9374774442 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1744 Ne 42nd Ave Portland OR 97213-1537 Ph: (503) 287-0072 | 1744 Ne 42nd Ave Portland OR 97213-1537 Ph: (503) 287-0072 |
| NPI Number | 1659006500 |
|---|---|
| Provider Enumeration Date | 07/22/2022 |
| Last Update Date | 10/25/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659006500 | NPI | - | NPPES |
| D11225 | Other | OR | DENTAL BOARD |
| 1124408778 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
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