| Diagnostic Lab Ohsu Dentistry Sch | |
|
2730 Sw Moody Ave Sd-path Portland OR 97201-5042 | |
| (503) 494-8904 | |
| Not Available |
| Full Name | Diagnostic Lab Ohsu Dentistry Sch |
|---|---|
| Speciality | Dentist |
| Location | 2730 Sw Moody Ave, Portland, Oregon |
| Authorized Official Name and Position | Jeffrey Stewart (PRESIDENT) |
| Authorized Official Contact | 5034948904 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diagnostic Lab Ohsu Dentistry Sch Po Box 10076 Van Nuys CA 91410-0076 Ph: (805) 578-8300 | Diagnostic Lab Ohsu Dentistry Sch 2730 Sw Moody Ave Sd-path Portland OR 97201-5042 Ph: (503) 494-8904 |
| NPI Number | 1609837574 |
|---|---|
| Provider Enumeration Date | 03/30/2006 |
| Last Update Date | 08/04/2014 |
| Medicare PECOS PAC ID | 7618962176 |
|---|---|
| Medicare Enrollment ID | O20040415000871 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609837574 | NPI | - | NPPES |
| 182769 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | (* (Not Available)) | Primary |
| 291U00000X | Clinical Medical Laboratory | (* (Not Available)) | Secondary |
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