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15495 Sw Sequoia Pkwy Suite 120 Portland OR 97224-6100 | |
| (503) 684-8445 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 15495 Sw Sequoia Pkwy, Portland, Oregon |
| Authorized Official Name and Position | Ken W Waddell (OWNER) |
| Authorized Official Contact | 5036848445 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
15495 Sw Sequoia Pkwy Suite 120 Portland OR 97224-6100 Ph: (503) 684-8445 | 15495 Sw Sequoia Pkwy Suite 120 Portland OR 97224-6100 Ph: (503) 684-8445 |
| NPI Number | 1356530422 |
|---|---|
| Provider Enumeration Date | 10/15/2007 |
| Last Update Date | 10/15/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356530422 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D5796 (Oregon) | Primary |
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