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13765 Nw Cornell Rd Suite 100 Portland OR 97229-5300 | |
| (503) 643-9855 | |
| (503) 626-7154 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 13765 Nw Cornell Rd, Portland, Oregon |
| Authorized Official Name and Position | Maryam M Motlagh (PRESIDENT) |
| Authorized Official Contact | 5036439855 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
13765 Nw Cornell Rd Suite 100 Portland OR 97229-5300 Ph: (503) 643-9855 | 13765 Nw Cornell Rd Suite 100 Portland OR 97229-5300 Ph: (503) 643-9855 |
| NPI Number | 1811154271 |
|---|---|
| Provider Enumeration Date | 05/21/2008 |
| Last Update Date | 05/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811154271 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D7499 (Oregon) | Primary |
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