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8064 Se Harold St Portland OR 97206-5148 | |
| (503) 771-5444 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 8064 Se Harold St, Portland, Oregon |
| Authorized Official Name and Position | Robert Thompson (PRESIDENT/OWNER) |
| Authorized Official Contact | 5037715444 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
8064 Se Harold St Portland OR 97206-5148 Ph: (503) 771-5444 | 8064 Se Harold St Portland OR 97206-5148 Ph: (503) 771-5444 |
| NPI Number | 1508130121 |
|---|---|
| Provider Enumeration Date | 02/29/2012 |
| Last Update Date | 02/29/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508130121 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D4676 (Oregon) | Primary |
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