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5025 Se 28th Ave Portland OR 97202-4445 | |
| (800) 813-2000 | |
| (503) 286-6879 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5025 Se 28th Ave, Portland, Oregon |
| Authorized Official Name and Position | Kenneth R Wright (VP DENTAL CARE SERVICES) |
| Authorized Official Contact | 5038134660 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
500 Ne Multnomah St Portland OR 97232-2023 Ph: (800) 813-2000 | 5025 Se 28th Ave Portland OR 97202-4445 Ph: (800) 813-2000 |
| NPI Number | 1265984546 |
|---|---|
| Provider Enumeration Date | 11/02/2016 |
| Last Update Date | 06/01/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265984546 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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