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2115 Ne 42nd Ave Portland OR 97213-1321 | |
| (503) 281-8110 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2115 Ne 42nd Ave, Portland, Oregon |
| Authorized Official Name and Position | Erin Irvin (OFFICE MANAGER) |
| Authorized Official Contact | 5032818110 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2115 Ne 42nd Ave Portland OR 97213-1321 Ph: (503) 281-8110 | 2115 Ne 42nd Ave Portland OR 97213-1321 Ph: (503) 281-8110 |
| NPI Number | 1770867962 |
|---|---|
| Provider Enumeration Date | 10/05/2011 |
| Last Update Date | 10/05/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770867962 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 8604 (Oregon) | Primary |
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